🏥 The Future of Payor Transparency Data Strategy

Diving into the future of price transparency and leveraging data across the provider enterprise. Plus, how different provider groups have found success with price transparency data, and practical payor-provider negotiation takeaways from my series with After Transparency

PARTNERED WITH Happy Thursday, Hospitalogists!   Today we wrap up the wonderful, fun series on payor price transparency. In this newsletter, I'm sharing specific examples of current and future use cases for the data, why finding the right solutions provider and partner is half the battle, and key takeaways from all 3 parts for your perusal.   I hope you enjoyed this series, and I wanted to give a big thanks to the great After Transparency team for their help and expertise in guiding Hospitalogy through the black box of payor price transparency data. Shout out Pete and Jon.   Let's dive in! Was this email forwarded to you? Subscribe Here SPONSORED BY AFTER TRANSPARENCY Board just lit a fire under your team? Project deadline looming? Now's the time to act. After Transparency is ready to help you turn payor price transparency data into serious negotiation power and strategic fuel for decision-making.  Whether you're rethinking your contracts, working to complete a project before year-end, or trying to get a jump on 2026, don't let payors undercut you and don't undercut yourself by not knowing your true market position and value.  Get experts on your side who know how to use this data and have done it before, successfully and at scale. You've got more leverage than you think. Use it. Talk to Us The Payor Price Transparency Executive Summary If you get nothing else from this newsletter or my series on payor price transparency, understand the following: If you are a provider organization reading this newsletter and you've never leveraged payor transparency data for strategic or financial reasons, you need to close this window and go play catch-up ASAP. If you've tried to use it in the past but found those efforts unfruitful, it is 100% worth the cost to to try again, and I recommend a high-touch partner like After Transparency. Payor price transparency data will eventually be integrated into the way most providers, payors, and services that support them use data in general as part of a broader, data-driven holistic strategy. The data is usable and effective - but you need the right partner or team to help decode and tell the right story with data. Over time, we will see countless use cases emerge for transparency data as provider organizations move from siloed into enterprise-wide strategic thinking. Don't get left behind. PRICE TRANSPARENCY PART 3 Data in Action: How Different Provider Organizations have Leveraged Price Transparency Data The below are just a few examples or case studies - all blinded for sensitivity purposes (because everyone is terrified of payor repercussions, mind you) - of different healthcare services providers I've talked to in recent months and how they've worked with solutions providers in the price transparency space to significantly alter the course of their entire organization for the better. Let's start with hospitals and health systems.   The Hospital / Health System:   Given the scale and level of volumes in all kinds of specialties and service lines, hospitals and health systems hold the biggest opportunity in leveraging payor price transparency data. Rate negotiation is really just the beginning. Over time, as systems move from siloed thinking toward an enterprise-wide mindset, we're going to see strategy, finance, and even marketing teams infuse transparency data over a broad range of use cases. Here are some examples I've both heard of and can conceptualize off the top of my head: To start off - simple rate negotiation and leverage. Identifying high-impact areas to test (e.g., specific geographies or markets, service lines, payors, or categories), then expanding the scope from there. From this use case alone, hospitals can see upwards of 10x ROI when using the right solutions partner or consultant. Site-Neutral and Outpatient Migration Trends. What's the impact of shifting an HOPD to an ASC? How are outpatient rates evolving over time? What's my exposure to any potential site neutral changes, or inpatient only removal? De-risking your M&A, partnership, and de-novo strategy. Hospitals are looking to build out ambulatory density in attractive and growing markets, or to preserve market share. As your corporate dev team is identifying potential targets in urgent care, imaging, physician services, or anything else, your team can leverage payor transparency information to understand the target's rates, build into your model, and determine whether acquiring or moving into that market makes sense. For instance - if an imaging center has an excessively high MRI rate, acquiring it or partnering with that platform is inherently riskier given its position versus the broader market rate. Now you know that information and can plan accordingly. Just one of many examples in strategic finance and growth land. Patient Acquisition and Broader Consumer Strategy Incorporation. As more consumer-forward elements get introduced in healthcare (highlighted in my interview with Baylor's Pete McCanna), health systems are taking notice. I can conceive of a world where hospitals advertise - and prove - that they are the lowest cost, highest quality care setting, or that hospitals eventually enter a world where they're advertising certain shoppable elective procedures to patients as an acquisition strategy, and show their competitor's comparable rates as a proof point in advertising. Is that too crazy or out there to say? Direct contracting or VBC. Similar to payor negotiations, but at a high level, hospitals that know their market positioning and relative standing on rates can, in theory, communicate their value better to employers or in other future direct contracting arrangements. Additionally, the economic upside of contracts in value-based care is a function of FFS benchmarks, so knowing the relative rates in your region can help with risk or quality-driven decision-making. Moving beyond health system capabilities, here were some notable case studies and results from other types of provider orgs leveraging payor price transparency data.   The Physician Practice:   An independent primary care group found themselves gridlocked in payor negotiations for nearly a year. The practice faced the economic realities that many primary care organizations face today: patient visits are chock full, but major struggles to get by given dismal reimbursement and inability to get paid competitive rates for their services.   They suspected they were getting shafted on rates and even considered going out of network with this particular payor. But the group didn't think they had the leverage nor the expertise to spar toe-to-toe with one of the largest payors in their state. Still, they were determined. So they did exactly that after diving into the payor transparency data. When leadership saw how far behind on rates they stood when compared to their broader market, the entire team's collective eyes popped out of their skulls.   Leveraging the transparency data, the primary care practice dug their feet in and successfully renegotiated its contract with its largest commercial payor, securing a 240% increase over 2 years. (Hey payors, by the way…shouldn't we be helping out our primary care providers here?).   Even primary care providers can level the playing field when armed with the right data. Change the narrative, and tell the right story equipped with data.   The ASC:   A large multispecialty ASC understood the promise of payor price transparency data but couldn't figure out the nuance of the data. Leadership had no insight into their rate information or market positioning. They had even tried a transparency partner in the past but to no real effect, which led to a ton of frustration. Then, their team found the right partner, and the information unlock led to a wealth of insights that has resulted in the ASC's operational flourishment: They understood their market position much better, seeing market rate benchmarks but also specific rate information for competitors. Seeing this information allowed them to understand which service lines or procedures it made sense to expand into and others to stay away from. They, of course, had better data-driven payor negotiation ability. Finally, and most interestingly, they were able to make significant technology investments into new surgery systems knowing the procedures would be covered, and how much to expect, allowing ASC leadership to make much more informed financial decisions driven by specific, market-level reimbursement data. The investments also significantly improved surgical capacity and expanded patient access in a lucrative specialty in a lower cost environment than competitor hospitals. You're probably noticing a common theme with all of these: whether you're an urgent care platform, physician practice, hospital, or ASC, you need data to tell a better, more compelling story - and to invest in the future growth of your organization.   And to tell the right story, you need a partner who cares deeply enough to work alongside you in the sticky web of payor price transparency data. Tips and Tricks in Working with Payor Price Transparency Solutions Providers and Consulting Firms Based on discussions with experts in the space, here are some questions and other considerations you should weigh when opening up the black box of payor price transparency data and finding a partner to work with: Does the vendor play both sides (payors and providers), or do they exclusively advocate for hospitals and provider groups? Trust is an important part of this partnership, especially in a culturally sensitive area like rate information. For instance - After Transparency only works with providers. Payor transparency data is pointless without deft interpretation. How is the data delivered? Is it clear, structured, and easy to interpret? Can you make actionable decisions based on the deliverable, or does it require further interpretation? Is the team you're partnered with working alongside you to walk you through the data, identify critical rate differences, and help you understand exactly what you're seeing? Can you work with this vendor to eventually make broader strategic decisions that can transcend beyond payor negotiation? Are they a true partner going above and beyond to maximize odds of success? What is the payment structure of the contract with the solutions provider or consulting firm? Are they willing to work on a contingency basis to kick off a small initial engagement? If you're unsure on scope, start with a small but easy win as a test. Or prioritize a key service line. I'm biased, but if you're stuck on where to turn, reach out to After Transparency. I've come to know their team quite a bit over the last few years and have nothing but good things to say about the way they conduct business. If they're not the best fit for your needs, they'll point you in the right direction. Because - as a true provider-exclusive partner ought to be - they want to see you succeed, and they want you to know that a better path forward equipped with provocative, actionable data - is out there for you. SPONSORED BY AFTER TRANSPARENCY Whether you've never used payor price transparency data, or tried using it before but didn't get anywhere, you're not alone.  Many providers waste time, money, and patience before calling After Transparency.  Get a jump on the competition. Talk to the team that leverages the data and their expertise to help you: Negotiate better rates Clarify the ROI of new markets and new services Eliminate or restructure unprofitable lines Align pricing with quality and outcomes Reach out to After Transparency. Take Action Now Bonus! A Tactical Guide: Key Takeaways for Payor Negotiation and Incorporating Price Transparency Data Here are some final executive takeaways for you guys on payor-provider negotiation as seen in parts 1 and 2.   Data and Negotiation Strategy Price transparency data has dramatically improved negotiation capabilities compared to previous methods like secret shopping or purchasing claims data The cost of not negotiating is substantial - hospitals may be leaving hundreds of thousands to millions of dollars on the table ROI on price transparency data and consulting services can be significant (After Transparency sees 10x on average) Transparency data has limitations - it doesn't include outlier payments or trauma carve-outs - so make sure you understand what you're doing and where those limitations lie   Overcoming Barriers Many providers avoid negotiations due to fear - particularly fear of having rates lowered. It's a huge cultural barrier in healthcare. First rule of the rate - you don't discuss the rate! Contract termination concerns prevent hospitals from approaching payors for fear of getting booted out of network Organizations worry about spending money on data and consultants with no guaranteed return   Effective Approaches when Negotiating Build compelling narratives beyond just data - tell stories about patient journeys and cost comparisons Highlight the cost differential if patients went to higher-cost settings (like ED vs. outpatient) or if you shuttered services or went out of business altogether (another player would be larger and have even more leverage, driving consolidation, which is proven to increase costs) Consider approaching large employers in your market if payors won't budge - demonstrate how your facility offers cost savings Target the right person at the payor - relationships matter, and getting your case to decision-makers is crucial   Market Strategy Understanding your true competitors and strategically defining your market is key Size doesn't always dictate negotiating power - smaller providers can successfully negotiate with proper data Expertise in interpreting the data is essential - "data is nothing without expertise" This is a new negotiation paradigm - providers are still developing best practices for using transparency data with payors   Negotiation Leverage Network adequacy is a powerful argument - payors cannot sell business in markets without adequate provider coverage For one-hospital towns, leverage can come from stating that the payor's only options are accepting fair rates or seeing the hospital close/get acquired Board support is crucial - "wimpy boards" afraid of losing contracts reduce leverage   Payor Tactics Payors often gaslight providers by claiming data doesn't exist or that they're leveraging the price transparency data is being interpreted incorrectly (even if the data is coming from the payor's own website!) Deliberate timing tactics (negotiating during holidays) are used to pressure providers Payors benefit from dragging out negotiations, as providers continue with old contract rates Quality bonuses are often excluded from transparency data, which is a "malicious compliance" tactic payors use to suppress reported rates   Strategic Approaches Set firm deadlines to stop negotiations - this is often the only tactic payors respond to Understand percentage-of-charge arrangements - if rates seem low despite good percentage terms, examine your chargemaster Consulting expertise can be valuable, particularly for code-level analysis and identifying specific opportunities for rate improvements Many hospitals have achieved significant rate increases (100%+) with proper data and negotiation strategies MISCELLANEOUS MADDENINGS I just wrapped up a great time in Nashville! Sessions recap coming this Tuesday. The folks in Nashville are great hosts and very friendly. I always enjoy my time in the city.   Hook em! Looks like the game is gonna be a rainy one on Saturday which will make things a defensive slugfest in the swamp. Thanks for the read! Let me know what you thought by replying back to this email.   — Blake   Get your brand in front of 49,100+ executives and healthcare decision-makers. Let's Partner 🏥 Hospitalogy Membership I'm building a community of leaders in strategy, finance, and ops at hospitals and health systems to help us connect, learn, and grow together. Join the movement here. Workweek Media Inc.  1023 Springdale Road, STE 9E Austin, TX 78721   Want to ruin my day? Unsubscribe.