Medical societies, associations, and colleges play an important role in the American healthcare system, supporting the millions of current and aspiring clinicians who deliver frontline care to patients every day. Among other goals, these organizations seek to level the playing field for their members in negotiations with health plans and insurers by advocating for equitable payment policy. Historically, these organizations’ ability to advocate for their members has been limited because they did not have a systematic picture of how rate reimbursement data was structured within and across specialties and markets.
That all changed in 2020, when new federal price transparency rules mandated the disclosure of payer rates. Medical societies, associations, and colleges—as well as their members—now have full access to in-network and provider negotiated rates, historical out-of-network allowed amounts, and drug pricing information.
Insights from this vast pool of price transparency data can greatly enhance these organizations’ missions to advocate on behalf of their members, but most seem unaware that the data is available to them, how they could use it, or how to extract meaningful insights.
Three Key Benefits of Price Transparency Data for Societies, Associations, and Colleges
Leveraging price transparency data can inform education, research, and policy advocacy for medical societies, associations, and colleges.
Enhancing education
Analysis of price transparency data be adapted for use in continuing education, workshops, and seminars that organizations offer to their members. Relevant topics might include how to recognize gaps in payment rates within certain markets, or tips for negotiating successfully with payers.
Advancing research
Price transparency data are rich pools for applied research. For example, a society, association, or college could investigate how rates changed over time for commercial payers, or how payment intricacies currently vary from payer to payer. Price transparency data also allow these organizations to benchmark prices by payers in a particular region against national standards, uncovering potential geographic disparities in reimbursement levels. This is valuable evidence for an organization’s lobbying efforts.
Boosting Advocacy
Medical societies, associations, and colleges are important advocates on behalf of their members for more equitable rates. Making a compelling argument to public and private entities requires an organization to have credible evidence of discrepancies in payment practices between regions or markets. Insights from price transparency data can provide those proof points.
Imagine that a society has members in Region A who are concerned a particular insurer is not paying them rates that are in line with nearby regions. Advanced analysis of price transparency data can help the society survey the landscape to determine if the complaint has basis. If members in Region A are being paid lower rates than providers in Region B next door, the society has hard data to back up their advocacy efforts with that insurer or a relevant government entity.
Offering Price Transparency Tools to Members
Medical societies, associations, and colleges can also serve as a gateway for their members to access price transparency data themselves. By offering price transparency analysis tools to members, organizations can help them:
- Improve negotiations with payers: Price transparency data allows providers and practices to understand their position in the market and offers them the data they need to push for better rates with current or new payers.
- Gain a competitive advantage in their market: By understanding the pricing trends in their markets, providers and practices can align their prices to attract more patients.
- De-risk decisions about new service lines: Insights from price transparency data can help providers and practices gauge the return on investment for staff growth or equipment purchases.
- Guide decisions about geographic expansion: Providers and practices can predict the rates they would be paid in new regions or states before making expensive investments in expanding their footprint.
How Price Transparency Can Benefit Patients
Medical societies, associations, and colleges exist to serve their members, but they also indirectly serve patients. When health plans and insurers pay providers in one region much higher rates than providers in another, those receiving lower reimbursement rates may reduce services, close facilities, or stop accepting patients from low-paying insurance plans. This would reduce access to services for those patients. Those providers may also need to bill for the difference if payment does not cover the full cost of care, which increases out-of-pocket costs for the patient.
Providing a level playing field for negotiations between providers and payers offers myriad benefits to patients, from improved access to care to lowering healthcare costs and increasing trust overall in the healthcare system.
Finding the Right Data Solutions Partner
Despite the many benefits, deriving insights from price transparency data is easier said than done. Working with a trusted data solutions partner provides societies, associations, and colleges with the skillsets and resources needed to realize the full value that price transparency data can bring.
Although these organizations and their members can access raw price transparency data on their own, they are likely not equipped to get much from it. Price transparency data is massive and complex. It would require considerable in-house expertise and resources to store, clean, and apply advanced analytic techniques to maximize their value. To gain the critical insights that can power education, research, and advocacy efforts, these organizations should seek a data solutions partner. Such a partner can offer a full suite of services including:
- Analytic-ready data that is regularly validated to deliver reliable results
- Custom analytic tools and a user-friendly interface that users can understand regardless of their tech fluency
- One-on-one consultation rooted in the partner’s experience in healthcare markets and policy as well as the society’s needs and goals.
Mathematica is a powerful data solutions partner for medical societies, associations, and colleges. We offer comprehensive access to data from national and regional health plans, provider-specific Medicare rates, and Medicare and Medicaid claims data. Our data experts transform vast amounts of price transparency data into structured, trusted insights. With more than five decades of experience at the intersection of data analysis and healthcare policy, we offer one-on-one consultation to help turn insights into strategies for these organizations and their members.
To learn more about how Mathematica can help enhance your support for your organization’s members, please contact us today. For societies, associations, and colleges focused in ophthalmology or those professionals that support ophthalmology, we encourage you to check out Healio Price Compass.
