Rate Benchmarking

Develop Pricing Strategies

Data-driven insights from the health plan price transparency files to inform contract negotiations

Benchmark Your Rates
Comparisons of rate and quality across provider organizations and payers

The market rate has been revealed – and it’s lower than you think.

For decades, pricing strategies in the health economy have had little effect because of information asymmetry between the providers of healthcare services – physicians, clinics, surgery centers and hospitals – and health insurers. CMS’s Transparency in Coverage initiative changes all of that, revealing the true market rate – if you can navigate the scale and complexity of the health plan MRFs.

Missing Rates

Hospital price transparency solutions do not contain ambulatory and professional rates

Flawed Interpretations

Many vendors can download the MRFs, but “tech bros” do not have the healthcare expertise to interpret their contents

Irrelevant Rates

Phantom rates are impossible to remove without an accurate provider directory

Benchmark rates to negotiate with leverage

Understand how your rates compare to your competitors by analyzing reimbursement patterns across markets, services and payers.


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Comparison of negotiated rates across health systems in a market

Expose unwarranted variation in negotiated rates

  • Analyze commercial reimbursement variation by CPT and DRG
  • Compare professional and facility rates to market and competitive benchmarks
  • Contextualize market rates with market share

 

Competitive Intelligence →
Service Line Growth→

Rendering of negotiated rates for a single provider at two locations between different payers

Support contracting and negotiation

  • Equip managed care teams with market-specific reimbursement data
  • Benchmark reimbursement by plan, geography and procedure

 

Network Integrity→
Health Plan Price Transparency →

Negotiated hospital rate vs. 30 day mortality for ms-drg 190

Identify opportunities to deliver greater value for money

  • Identify services where quality and rate are not aligned
  • Support strategic shifts toward lower-cost, high-value delivery models

 

Field Guide – Pricing Strategies →

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