The payer and hospital price transparency landscape is “moving past the point of reluctant acceptance” as more healthcare organizations become compliant and vendors look to build on the available data, Turquoise Health CEO Chris Severn said in a state-of-the-industry report released by the price transparency data startup.
Nearly 5,400 hospitals, or 84% of the roughly 6,400 applicable hospitals, have posted a machine-readable file with pricing data as of the end of Q1 2023, according to the company’s second Price Transparency Impact Report.
About 4,700 (74%) posted data negotiated rates, more than 4,500 (70.6%) have posted cash rates and over 4,600 (75.4%) have surgery rates available online, according to the report.
Those numbers are up from the company’s fall numbers, which listed about 4,900 (76%) hospitals with a machine-readable file, nearly 4,200 (65%) with negotiated rates and almost 4,100 (63%) with cash rates.
“The increased compliance numbers usher in a transformational era where data will be embedded in revenue cycle workflows, contract negotiations, and become an integral part of running a savvy healthcare organization,” Turquoise wrote in the latest report.
Payer compliance, though “far from perfect,” has increased at a faster rate than seen among hospitals, the company wrote.
Per the report, the initial 68 payers whose price transparency data was online rose to 111 by October, spiked to 164 just a month later and now sit at 183 as of the end of March.
Here Turquoise acknowledged the oft-reported volume and unwieldiness of the data released by payers, as well as some ambiguity regarding the true size of payers’ networks—all of which make the creation of third-party price comparison tools and other applications “more nuanced” than the provider side, the company wrote.
“If the government is aiming to require all insurance companies to publish the rates for all items and services, which we at Turquoise fully support, the output will, by nature, be nuanced and quite large,” the company wrote.
That said, the information is still usable if third parties have approaches in place to refine the raw in-network data, the startup wrote.
“For example, our technical team employed a number of duplication reduction techniques to eliminate the rate-level redundancy that existed across 300+ Anthem files, yielding a 96.6% reduction in the number of negotiated rates,” Turquoise said.
Another key milestone for the price transparency movement is the increasing number of startups and innovators flocking to the space. Turquoise said the past year has seen “a wave of venture funding flow into the early-stage market for price transparency,” and specifically called out Milu Health (proactive health spend savings for patients and employers), Certainly Health (consumer-facing booking with set prices) and Finestra Health (crowdsourced price transparency data from patient bills) as its competitors of note.
“We anticipate these startups will grow in size and service offerings as [No Surprises Act] matures,” Turquoise, which just closed its own Series A less than a year ago, wrote. “The notion that patients can book an appointment with knowledge of the cost in hand is transformational in an industry previously.”
Turquoise’s report includes over 5,000 hospitals’ machine-readable files and 810 million negotiated rates published by healthcare organizations, with payer data representing all sites of service and over 95% of the country’s commercially insured lives. Notably, its methodology (detailed in an October blog post) has led to somewhat higher compliance totals than those calculated by other watchdog groups.
Slow price transparency compliance has landed hospital groups on hot seat throughout the last couple of years.
The critiques have made their way to Congress, where last month several members of the House Energy and Commerce Committee’s health subcommittee grilled price transparency experts (including Turquoise’s Severn) on what’s needed to bring more hospitals in line. He and others broadly advocated for greater standardization across the submitted files and more meaningful financial incentives for compliance.