Accessing the Power of Price Transparency Data to Help Drive Growth, Inform Payor Negotiations

The healthcare industry has long been criticized for having a complex and opaque pricing system. In response, the federal government enacted a series of rules to push hospitals, health systems, and healthcare payors to provide greater visibility into their service rates. Beginning in 2021, the Hospital Price Transparency Rule required hospitals operating in the United States to provide clear, accessible pricing information online. Then in 2022, the Transparency in Coverage rule required health plans and health insurers to publish their in-network rates. 

While the price transparency rules are primarily designed to bolster competition and empower patients to get the best care for their money, the resulting data can also benefit healthcare organizations. Yet, most organizations do not have the time or resources to sift through the mountains of data made available through the federal rules. 

Strata’s Payor Rate Transparency (PRT) data set gives healthcare leaders that access. It leverages massive machine-readable files released by payors as a result of the Transparency in Coverage Act. Strata uses advanced data science techniques to clean, validate, and enhance the data, making it accessible and easy to analyze.  

The PRT data allow healthcare leaders to build upon insights gained from other price transparency tools, such as Strata‘s Market Reimbursement Intelligence (MRI) tool. MRI also leverages Strata’s proprietary All-Payor Claims Data (APCD), allowing healthcare leaders to analyze market rates by payor, provider, CPT code, and/or service line. 

Having access to a combination of PRT data and MRI gives organizations a more complete view of market reimbursement data. With this healthcare reimbursement intelligence, healthcare leaders can define effective pricing strategies, negotiate more competitive rates with payors, and assess opportunities to enter new markets.  

Insight into payor rate transparency data and market trends  

With tools that make payor rate transparency data more readily accessible, healthcare leaders can view a whole market’s rate structures at a glance. They can pull reports and view data visualizations by service area, CPT code, payor, provider, and provider geography.  

Healthcare leaders can compare negotiated rates side by side from organizations nationwide. Together, MRI and PRT span a range of care site types, including commercial, Medicare fee-for-service, managed Medicare, and Medicaid.  

This knowledge equips healthcare leaders to better understand how their organizations’ rates compare to the broader market. It enables them to assess market trends and determine competitive pricing strategies. It also helps them ensure their prices both align with market expectations and support sustainable growth. 

Negotiate better contracts with payors  

Contract negotiations have significant implications on a hospital’s financial performance. Healthcare leaders that come to the negotiating table prepared are better equipped to negotiate a favorable outcome and profitable contracts. A large part of that preparation involves understanding the current market.  

According to a recent report by McKinsey, U.S. healthcare prices can vary by 40-50% within a metropolitan statistical area. This indicates a substantial opportunity for healthcare organizations to negotiate better rates with payors.  

Healthcare leaders can use price transparency tools to gain insights into high, average, and low reimbursement comparisons by payor and code. Armed with such information, they can more effectively approach payor negotiations.  

Enter new markets with confidence  

Many predict 2025 will be a busy year for healthcare investments. PwC believes there will be a robust market for healthcare mergers and acquisitions. McKinsey forecasts significant growth in outpatient care settings, home health services, and physician services, as healthcare organizations expand their scope of care.    

While opportunities abound, healthcare leaders must carefully assess how and when to enter new markets. Without the benefits of comprehensive data and insights, leaders risk making decisions that aren’t financially or strategically sound.   

Healthcare leaders can leverage Strata’s MRI tool and PRT data set to assess the financial viability of new market entries or service line acquisitions. By analyzing reimbursement rates by payor, provider, or service line, leaders can better understand market shifts over time and gauge potential return on investment (ROI). This intelligence also gives leaders valuable ammunition to present a compelling case to their board and executive team for growth plans. 

With unprecedented transparency into reimbursement rates nationwide, the MRI tool and PRT data set make it easy to objectively compare rates. They equip healthcare leaders to negotiate fair reimbursement with payors. They also provide invaluable insights for assessing the revenue potential of entering new markets to ensure sustainable growth.  

To learn more, schedule a demo.