In 2022, CMS passed the Health Plan Price Transparency Final Rule enabling full visibility into every provider's contracted rates. Unfortunately, this data is trapped in large, cumbersome machine-readable-files (MRFs). We extract data from these files into a human friendly analysis.
• Competitor benchmarking
• EIN/NPI identification
• MRF JSON data extract
• Data interpretation & presentation
While Medicaid rates are often publicly accessible, it can take hours of research with strong attention to detail to get accurate and useful information. We can pull and analyze this Medicaid rate data in a way that helps your organization achieve its goals.
• Market rate benchmarking
• Regulatory considerations
• Rate legislative monitoring
We can help with other analysis related to growing your organization and expanding access to care. We leverage our expertise to deliver data-driven insights that will help you get an edge on your competition.
• Rate policy monitoring
• Supply / demand analysis
• New market identification
• Value-based strategies
There often are material rate disparities between local providers for the same payor
Within one local market, there was a 47% gap between the in-network rates for ABA therapy providers with the largest commercial payor. The lowest paid provider was unaware of this disparity and was able to leverage rate data to achieve its largest rate increase in firm history.
State-level politics can drive large differences in Medicaid reimbursement
For residential SUD treatment, there were significant differences in Medicaid rates between states. Some states enabled favorable unit economics while others reimbursed at or below the cost of care. Leverage data to identify high-quality de novo markets and inform policymakers of the need for a rate increase.
