The rise of price transparency is rapidly reshaping the healthcare analytics landscape in multiple ways. It is quickly becoming a transformative factor for provider organizations looking to negotiation their payer contracts, including hospitals, managed care entities, large specialty clinics, and private practices. By increasing access to pricing information, it introduces a new perspective on fair market value—an area previously guided by either Medicare percentages or survey data. With the ability to compare prices across providers and organizations, and then ultimately assess the true cost of care in relation to quality, healthcare leaders can be much more strategic in their planning. They can pinpoint inefficiencies, negotiate more favorable payer contracts, and ultimately improve value for patients while safeguarding long-term financial success.
Background
It’s important to note that there are two price transparency rules.
RULE #1: In 2021, hospitals operating in the United States for the first time were required by the federal government to provide clear, accessible pricing information online about the items and services they provide. This program was meant to be patient and consumer-facing, and typically this is what is first thought of when discussing price transparency
RULE #2: Following July 1, 2022, most commercial group health plans and issuers of group or individual health insurance across the country were also required to disclose their proprietary pricing information of negotiated rates for healthcare services between insurer and provider under the new Federal Price Transparency Rule. The stated purpose of this rule is “empowering consumers with the necessary information to make informed health care decisions.” However, provider organizations, especially those that currently have value-based care arrangements, or those looking to engage in value-based care arrangements, can also benefit greatly from price transparency data.
Price transparency data can now be used not just by provider organizations, but also by health plans, self-funded employers, and investors. Using machine-readable files from payers, healthcare organizations can analyze and differentiate negotiated commercial pricing structures among competitors.
Focus
Now that you have an understanding of the different rules, the focus of this blog is specifically centered around how provider organizations can leverage this price transparency data, including (but not limited to):
Guidance to help with payer negotiations for payer relations teams
Benchmarking fair market value compensation for improved market positioning
· Developing preferred provider networks for value-based care arrangements
· Revenue cycle management
Price transparency data can be leveraged across the entire risk continuum. As organizations move from fee for service to fully capitated models, price transparency and understanding fair market value will only become more critical at every step. The process of shifting from volume to value varies in length, but understanding price is an important pillar.
Data Complexity
The healthcare transparency in pricing regulation stipulates that commercial health plans make publicly available Machine Readable Files (or MRFs) containing the raw data representing their negotiated proprietary provider contracts. As the name would suggest, these files must be machine readable. If a consumer goes to their health plan website to download the files, they are absolutely able to do so. In fact, I encourage any reader to try it! Be forewarned, however, the download that you receive is complete nonsense to the human eye. This is because the Federal Price Transparency Rule also specifies that the files conform to a highly complex format. Therefore, to successfully unlock actionable human-readable data from these datasets, a multi-layered technical process is required.
Contract Negotiation(s) for Provider Organizations
Subsequently, two new products recently launched by Revelar Analytics: Primo and Limelight, can showcase sample data from their dashboards. As you can see in the screenshot, this information was presented in an easy-to-understand format, with all the noise filtered out. It’s ready for provider organizations to dive in!

Revelar Analytics has 5 steps they recommend for provider organizations to take in order to prepare for a contract negotiation, leveraging price transparency data.
1) Prepare the data
2) Conduct a readiness assessment
3) Align organizational strength to contract terms
4) Review key performance indicators
5) Collaborate with payers
To learn more about how your organization can use price transparency data, don’t hesitate to reach out to the Revelar Analytics team to learn more about our products and services. Our seasoned data analysts, healthcare strategists, and technology innovators bring years of experience, unmatched clarity, and insight into complex data. With a passion for supporting our clients’ success, we deliver solutions that not only meet immediate challenges, but we also position organizations for long-term revenue growth. By choosing our consulting services, clients gain access to a team dedicated to ensuring your organization gains clear, actionable insights from price transparency data. Partnering with Revelar empowers your organization to navigate the complexity of price transparency and contract negotiation strategy with confidence and precision.
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