Official Healthcare Pricing Guide™ (HPG) Can Ensure Employer Health Plans Are Paying Fair Prices Following the Consolidated Appropriations Act, 2021 (CAA)

News provided by

Feb 06, 2023, 11:18 ET

HPG is the First User-Friendly Tool to Access Formerly Confidential Negotiated Prices from Recently Released CMS Transparency in Coverage Files

CORPUS CHRISTI, Texas, Feb. 6, 2023 /PRNewswire/ -- Denniston Data Inc. (DDI), "The Healthcare Transparency Company," has launched the Official Healthcare Pricing Guide™ (HPG), U.S. Medical Benchmark Prices from Transparency in Coverage and Medicare Data, with the largest and most accurate data available on negotiated medical prices in the U.S.

Phil Denniston, President & CEO, Denniston Data Inc.

The Consolidated Appropriations Act, 2021 (CAA) established protections for consumers related to surprise billing and transparency in health care. It created a unique opportunity by establishing the Transparency in Coverage (TiC) requirements, making available all negotiated prices from every healthcare payer to every medical provider for every service in the U.S., beginning in the latter half of 2022. These rules provided unprecedented access to proprietary price information. The resulting data can transform how payers and providers negotiate, and it can result in the elimination of unwarranted price variability. However, the datasets are massive and messy, and the value is contingent upon making the data interpretable and actionable, which DDI has done. According to Phil Denniston, President of DDI, "We believe increased transparency, in both costs and quality, is the key to improving outcomes in the U.S. Healthcare System. This will benefit both payers and providers, and most importantly, patients." CAA also included the No Surprises Act (NSA), which provided a new basis for out-of-network price negotiation, also included in HPG. Under CAA, self-insured employers have increasing fiduciary responsibility to their employees to ensure their healthcare prices are reasonable. This responsibility also applies to how health plans or TPAs bargain for their employer clients.

HPG is the First User Friendly Tool

Official Healthcare Pricing Guide™ (HPG) is available for public use after January 31, 2023, from all official US Government mandated data. Not only does it provide price transparency, but it uses a transparent process, unlike past healthcare pricing services, which may have been based on guesstimates or confidential sources. HPG provides tools for negotiating a "Fair Price." It covers all reimbursement codes, easily searchable: DRG (hospitals), HCPCS (doctors & other providers, including CPT & CDT), ICD codes, & RC (revenue codes), based on tens of billions of U.S. negotiated prices, after thorough quality control checking, using over 50,000 health plan non-duplicate files. Now you can access what used to be highly confidential, undisclosed information, at your fingertips. Employers can achieve compliance with CAA (Consolidated Appropriations Act) and NSA (No Surprises Act). CAA will make fiduciaries of self-insured employers for healthcare services they purchase. User pricing of HPG is based on number of employees: It is only $0.50 per employee (with a minimum annual fee of $1,000 and a maximum of $50,000).

Experience with Big Healthcare Data

The principals of DDI have considerable experience with creating value from very large healthcare datasets, creating several leading services in the past. More recently, DDI's sister service, Provider Ranking System™ (PRS), the largest and most accurate data available on medical providers in the U.S., is especially helpful in analyzing the TiC data. PRS has full details on over one million providers per year for 9 years, with every procedure performed, billed, and reimbursed. It ranks providers by service, nationally and locally, and it identifies high performing doctors. PRS approved and billed prices are also shown alongside TiC negotiated prices for comparison.

ROI of 1,000 to 1

In applying the HPG tool for a test case client, a typical mid-sized self-funded employer, it was shown to result in a return on investment of one thousand to one. By spending $1,000 on HPG, the client can save $1 million per year in healthcare costs. The secret was to target services where they are substantially overpaying in contract negotiated rates relative to HPG TiC benchmark rates. These services represented about 20% of total costs, where the client was overpaying by an average of 50% or more. After renegotiations, overpayments were cut by half on average. Citing the HPG "Fair Price" is key in the renegotiations. These negotiations may be by benefits consultants or TPAs on behalf of the employer, and it was important not to renegotiate services where currently paying at or below HPG benchmark. For this typical employer with about 2,000 employees, the HPG cost is $1,000 and annual savings are $1 million. For other employers currently overpaying on over 20% of services, savings may be much higher. For all employers, they would have fulfilled their fiduciary responsibility under CAA to ensure they are not paying excessive rates.

About Denniston Data Inc.
The mission of Denniston Data is to bring transparency into provider quality and costs, improving the efficiency and effectiveness of patient care in the U.S. Healthcare system. The principals of Denniston Data have together founded and built multiple enterprises in the healthcare field based on medical database and claims-analytics. Provider Ranking System™ and Healthcare Pricing Guide™ serve the needs of healthcare payers and providers. For more information, please visit https://www.dennistondata.com

Patricia Whelan
Denniston Data Inc.
+1 760-846-4930

SOURCE Denniston Data Inc.