New software allows payers and providers to query 500+ terabytes of enriched rates data in seconds
Clarify Health, a leading healthcare analytics and value-based payments platform company, released a no-code query engine within its Clarify Rates product, a price transparency intelligence software. Payers and providers can now instantly query 500+ terabytes of enriched price transparency data via the software’s user interface and generate reports on market prices in seconds. The Clarify Rates product contains institutional and professional rates from over 65 national and regional payers, including United Healthcare, Cigna, Aetna CVS, Humana, and many Blue Cross Blue Shield (BCBS) payers, and is constantly adding new data as it is released, providing access to the most comprehensive and up-to-date rate intelligence on the market.
Raw price transparency data contains trillions of records, is inconsistently formatted, includes gaps in reporting, and paints a convoluted picture of healthcare pricing in the commercial market today. Aside from its no-code query engine, what makes Clarify Rates unique is its enriched rates data. By enriching raw rates with claims data on 300M+ annual lives, the product displays prices that have been billed instead of millions of meaningless prices. Clarify’s data enrichment methodology uses claims volume to determine utilization and remove “zombie rates,” rates that are reported for providers who never have and would never provide certain services. The methodology also maps standard codes to service lines, estimates Medicare payments for those services, and calculates rates as a percentage of the Medicare payment. Additionally, by integrating insights from claims alongside rates data, Clarify adds the critical dimensions of service mix and volume. This enables the display of the weighted percent of Medicare prices (versus straight average) so users can better inform their understanding of the true economics and value delivered.
Users can also compare sourced rates across services, providers, and payers in any given market to quickly receive insight on their competitive negotiated rate standing against their peers.
Price transparency data coverage and quality
Since 2015, the Clarify Platform® has been managing massive data sets using big data efficiencies that are commonplace in the consumer and financial industries and provided the perfect infrastructure to handle the size and scale of price transparency data. Clarify has processed, analyzed, and compared data from approximately 5,600 hospitals and all large national payers since the inception of each data set to assess quality differences between the data sets. Here is what we have observed:
- Health plans are more compliant with price transparency regulations than hospitals, resulting in higher data coverage found across payer-sourced data.
- Hospital-sourced rates data is limited to hospital services (e.g., it is missing professional and ambulatory services). In contrast, more than 90% of unique negotiated rates reported by health plans reflect rates negotiated with professionals.
- Notably, CMS also did not require a standard schema for hospital machine-readable files (MRF) formatting, whereas health plans must follow a defined schema. This has led to a broader variation in hospital reporting format and quality.