Hello readers! As the Serif Health team sprints toward the end of summer and kicks off the fall season, we are excited to share the latest on how our customers - from health systems and provider groups to employers and TPAs - are utilizing price transparency data across their organization. In this case, it’s how they are using our archived price transparency data for nuanced historical analysis.   

As the original requirements for payers to publish in-network reimbursement rates first went into effect in July 2022, we now have nearly two years worth of monthly updated historical reimbursement data to help our customers analyze changes in the data over time. Current regulations don’t require health plans to archive any of the historical price transparency data they publish on a monthly basis - so that’s where we come in! Our team at Serif Health has taken care of the hard work to cleanse, process, and store that data for you to maximize the ability for anyone to utilize the price transparency data. 

By archiving the transparency data our data engineering team has processed this entire time, Serif Health customers have been able to unlock key insights and trends in the data - from tracking changes in reimbursement rates to analyzing provider and network growth across carriers and markets. 

Even at a quick glance above, we can see month-over-month changes in the number of in-network organizations and providers for a given health plan - with even richer insights as we dive deeper into the data itself. So without any further ado, let’s walk through some of the key ways to take advantage of historical price transparency data, analytics, and reporting.

Exploring Reimbursement Trends and Contract Negotiations Outcomes

One of the most common use cases for price transparency data is payer-provider contracting. While contracting executives can use current reimbursement data to understand existing reimbursement rates across its market or across a set of peer organizations, historical analysis can be even more powerful during contract negotiations. Now you can ask questions such as: 

• Are in-network reimbursement rate price distributions in a given market increasing or decreasing over the past year? How are these price distributions varying by payer or plan type?
• Did similar organizations get rate increases or decreases over the past year?
• What kind of contracting strategies are being employed in the market? 
  • Are groups getting uniform changes across their entire fee schedule or are there outsized changes to specific service lines or procedure codes?

Serif Health customers have been able to identify critical reimbursement trends through historical data access and reporting. For example, comparing BCBS Texas’s Blue Choice PPO’s June 2024 and July 2024 machine readable files showed that a health system’s rate negotiations resulted in a new contract with 6% rate increases across a broad set of inpatient and outpatient services! 

On the opposite end of the spectrum, Optum’s Behavioral Health’s MRF postings across June, July, and August 2024 showed several behavioral health organizations with reimbursement declines of 5% or more for standard one-hour psychotherapy visits. 

With historical MRF data at your fingertips, contracting insights and strategy can become much more nuanced and impactful.  

Exploring Provider Growth Patterns and Network Analytics 

However, historical insights are not just limited to trends in pricing. There is a significant amount of information on the contracted entities themselves, namely organizational and facility Employer Identification Numbers (EINs), as well as organizational and individual National Provider Identifiers (NPIs). This means you can ask questions like: 

• How are provider networks growing (or narrowing) over time across markets and carriers? Which payers and plans are growing their networks the most or the least across a given market or geography? How are network gaps changing? 
• Are specific payers adding more in-network hospitals and health systems? Are specific payers adding or losing in-network substance abuse counselors or other specialists of interest?
• How are specific provider groups growing over time - what trends are we seeing in their number of credentialed NPIs across different payers and markets? What provider groups and organizations are growing the fastest or slowest? 
• How are provider and network overlaps changing over time? Are specific providers expanding their organizational affiliations or are certain organizations recruiting providers from other groups more effectively?    

With historical analysis, Serif Health customers have identified the respective growth rates of various provider groups in their markets, as well as patterns with specific payers in terms of network and specialist growth, to help shape their market entry and provider recruiting strategies.  

If you are a healthcare organization interested in Serif Health’s historical price transparency data offerings, please reach out: https://calendly.com/serif-health. This is only the beginning for exciting analyses with historical price transparency data. Whether you want to explore some of the use cases above or have some new ideas for analysis, we are excited to help you along the way!