Price Transparency Analytics

Milliman Price Transparency Solutions for Payers and Providers

Demystify payer and provider contract pricing data for better transparency across the industry.

Milliman Price Transparency Solutions for Payers and Providers

The challenge

Hospital and health plan contract pricing data is available for the first time ever—but it is unwieldy and incomplete

Recent regulations require hospitals and health insurance payers to post contracted prices for medical services publicly online. However, the lack of consistency and accuracy makes this data difficult to consume and collate. Consumers need data that is comparable, accurate, easy to understand, and trustworthy to maximize transparency and choice. Payers and providers need fair price comparisons to use them during contract negotiations.

The solution

Powerful analytics applied to unified data improves transparency, clarity, and insights

Milliman Transparent unifies disparate data from thousands of hospitals and payers, using our vast claims and contracting experience to improve data quality and usability. More than just a data warehouse, our solution incorporates proprietary utilization profiles and standardized pricing to create case-mix-weighted percent of Medicare relativities that enable fair contract comparisons. Intuitive online tools simplify access, and an API is available for extracting data on demand.

FEATURES

Milliman Transparent features

Simplified access

For the first time ever, coveted payer and provider contract pricing data is made easily accessible and understandable.

Decision-ready data

Publicly available machine-readable pricing content is transformed into a unified, normalized, comparable data foundation.

Transparent data quality

Milliman healthcare industry experts and data scientists work together to flag data quality, trustworthiness, and sufficiency, so users can make informed choices about how to use the information.

Holistic view

In order to compare the disparate payer and provider contract information, Milliman has created utilization profiles by line of business and provider type. We combine the utilization profiles with our actuarial standardized price (GlobalRVUs) so that users can compare contracts with different contract structures and service codes.

Comparability

Actuarially sound percent of Medicare relativities for each contract and service type can also be viewed across markets and geographies.

Powerful tools

Get data on demand using a web interface or consume it using an API.

BENEFITS

Milliman Transparent benefits

Access competitive intelligence

Gain a deeper understanding of existing contractual agreements.

Improve contract negotiations

Harness data to gain leverage in payer and provider contracting efforts.

Perform comparative analysis

Understand your hot and cold spots, pricing anomalies, and network strength across payers and providers.

Inform patient decisions

Support greater price transparency in healthcare and enable more engagement and choice for healthcare consumers.

Enhance transparency across the healthcare ecosystem

Improve the market efficiency of contracting by enabling fair comparisons among providers and payers.

Effective January 1, 2021, legislation required hospitals nationwide to publicly post a machine-readable file containing negotiated prices for all services provided at the hospital.

Read the article

Milliman Price Transparency Solutions for Payers and Providers