As of July 1, in accordance with the Centers for Medicare & Medicaid Services’ (CMS) Transparency in Coverage rule, health plans have begun publishing machine-readable files (MRFs) containing in-network negotiated rates and out-of-network allowed amounts intended to inform consumers of the costs associated with a service or item before care is rendered.
Our Transparency Analytics transform these MRFs into valuable insights health plans can use for reimbursement benchmarking, network analysis, and cost transparency.
BHI's Transparency Analytics provides plans with:
Leveraging the industry’s most trusted data and analytics, BHI can help your plan unlock value in local markets and deliver insights on national trends. This level of integration not only accelerates your plan’s analyses and internal pricing and contracting strategies but also saves you valuable time and resources.
How your pricing compares to competitors in your markets
Which competitor plans are getting the most advantageous pricing in your markets
Which providers have materially different pricing than your competitors
How your network breadth compares to your competitors by market
How your pricing advantages/disadvantages impacts your group sales competitiveness
How competitors might use the pricing and network data to your disadvantage
BHI's reporting provides an easy-to-understand, color-coded overview of how your pricing compares to other health plans in a given geographical area. Your plan’s provider networking and contracting teams can drill down by county or region to view regional benchmarking data and compare services across specialties, noting where your plan falls short or excels in comparison to other health plans. In addition, you can analyze pricing for specific facilities and provider groups and by specific services to understand your competitive positioning.
Armed with this reimbursement benchmarking and cost transparency information, your plan can optimize its network strategy and strengthen its negotiating power.
Want to learn more?
BHI’s Transparency Analytics offering is flexible. Plans can select data flows only, or also include customized data visualization for their local area.
Find out more about how BHI can help you optimize your contracting and discount strategy.