Unveiling the True Price of Elective Healthcare Services

Strategic Insights -

In the complex landscape of healthcare pricing, it's easy for plans, brokers, and their clients to get left behind. The lack of clear, trustworthy, and up-to-date pricing data hinders their ability to negotiate fair reimbursement rates, design cost-effective plans, and create high-quality networks. As a result, they often lose money. Meanwhile, the healthcare industry is facing mounting cost pressure, with employers projected to experience health benefit costs rising between 6% and 9% this year. The recent government regulations requiring health plans and hospitals to provide rates-based data on all services have heightened the need for accurate pricing information.

Key Takeaways:

  • Negotiating discounts from sticker prices doesn't benefit commercial plans or brokers, as they still pay too much for healthcare services, leading to cost increases they must pass on to clients.
  • Plans and brokers struggle to optimize plan and network design for high-quality care due to the lack of pricing data that accurately reflects the true cost of care.
  • Effective negotiation requires more than just clean, trustworthy, and up-to-date pricing data; it also needs robust analytics tools to compare rates, curate networks, and improve competitive positioning.
  • Claritev's PlanOptix provides a unique combination of pricing data and analytics models that enable plans and brokers to contextualize healthcare costs, prioritize data sets, and make informed decisions about setting competitive reimbursement rates.
  • PlanOptix users can create high-performing networks and custom cost and plan comparison solutions, giving them a competitive advantage in the market.
  • Improved healthcare price transparency is a priority on Capitol Hill, and plans and brokers can turn to Claritev for insights that support their efforts to negotiate rates, create networks, and design plans that meet the needs of their clients and patients.

Statistics:

  • 6-9% projected health benefit cost increase for employers this year.
  • 125 billion price transparency records across over 160 health plans and 3.5 million providers.
  • 93% of the commercially insured and employer-sponsored population in the U.S. represented by Claritev's data.
  • Data Usability Rating: a proprietary assessment of data adequacy and coverage that helps plan and broker executives prioritize data sets.
  • 3.5 million providers covered by Claritev's data.

Sources:

  • Claritev
  • PlanOptix
  • Centers for Medicare & Medicaid Services (CMS)