Using Publicly Available Health Plan Pricing Data for Research and App Development
Publicly reported insurer price transparency files provide new information on healthcare prices, but they lack important context on utilization and episode-level costs and adjustments. Combining price transparency data with claims is necessary to accurately assess provider prices and healthcare cost variation.
The CMS price transparency rule requires insurers to publicly post machine-readable price data to help consumers, employers, and researchers better understand healthcare costs. However, questions remain about whether these files accurately reflect real-world prices and can be reliably used for research, price comparison, or consumer decision-making without additional context.
Published in Health Affairs Forefront, this study compared Elevance Health’s publicly reported price files with administrative claims data to assess how representative the price data are. Using colonoscopy as a case study, the analysis found that price files alone do not fully capture the nuances of actual costs and should be supplemented with claims data to support accurate research and consumer tools.
Related Public Policy Research
Arbitration Outcomes for Out-of-Network Medical Bills Under the No Surprises Act
This study, published in INQUIRY: The Journal of Health Care Organization, Provision, and Financing, compared final payments for out-of-network care from disputes that underwent arbitration under the No Surprises Act in 2023 to commercial in-network rates and Medicare rates.
Hospital Characteristics and Medicaid Hospital Prices
The cost of hospital care in the U.S. continues to be a central concern for health insurers, employers, and policymakers alike. This analysis found that Medicaid facility prices for several routine children’s procedures were significantly higher at children’s hospitals, critical access hospitals, and system-affiliated hospitals.
Coding for High-Complexity Office Visits on the Rise
The percentage of outpatient evaluation and management visits (office visits) coded as high-complexity has increased by more than 50% since 2006, adding to overall and patient-paid costs.