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Milliman, an actuarial and consulting firm, has partnered with Turquoise Health to increase health care price data transparency for market participants.
Tejas Inamdar, head of strategic partnerships at Turquoise Health, says that through the partnership, health care market participants will be able to access additional critical pricing data with which to make important care decisions.
“Access to data will be table stakes for market participants wanting to engage in health care negotiations,” he says. “The next phase of price transparency will be to draw actionable information. This partnership combines capabilities and enables more health care organizations to leverage this wealth of new information by combining negotiated rates with proprietary data on utilization, relativities, reference pricing and groupers.”
Milliman’s Grouper software is used to analyze and benchmark use and costs using the Health Cost Guidelines. The tool sorts medical and pharmacy claims data into hospital, surgical, medical and other benefits service categories using Health Cost Guidelines definitions, according to Seattle-based Milliman.
Beginning July 1, most group health plans and issuers of group or individual health insurance are required to post pricing information for covered items and services, following a 2019 executive order from President Donald Trump. Greater price data transparency can reduce time needed by employers for price discovery, assist employers with health benefit contract negotiations and help employees with health care costs, according to the release.
“Instead of spending precious time and resources just trying to wrangle the data, Turquoise and Milliman enable businesses to act strategically, making decisions based on data down to the market, cohort, and code level,” the partnership release states. “Price transparency data illuminates opportunities for improvement, arming healthcare stakeholders with the quantitative data they need to conduct granular analysis, generate insightful comparisons, and scrutinize competitor networks.”
The Transparency in Coverage Final Rule, issued by the Centers for Medicare and Medicaid Services, took effect January 1, 2021.The pricing data that exists for the industry and individuals is useful if it can be unlocked, said Mike Gaal, principal and consulting actuary with Milliman, in a release.
“The data set that has become available this year is the largest collection of healthcare data ever published,” he said. “The wealth of information has the potential to transform the industry—but gathering and deciphering all that data requires a unique blend of healthcare expertise and scalable technology.”
This payer data ranges from in-network negotiated rates to out-of-network allowed amounts for hospitals, surgery center labs imaging centers professional fees and durable equipment, according to the release.
“The availability of this data will affect every stakeholder involved in the healthcare interaction,” Inamdar added in the release.
For the partnership, Milliman will use its proprietary data enrichment tools and analytics to turn this machine-readable data into insights that can be used by businesses.
Turquoise Health is a health care technology startup that was launched in 2020. The company uses machine learning to assist with making health care price transparency data accessible, according to a spokesperson. Turquoise uses data engineering and machine learning to automate processing thousands of payer and provider files containing millions of records in multiple formats.