Mathematica, a data analytics consultancy, is providing a software-as-a-service solution to help Main Line Health use new plan price transparency data to drive strategies around managed care contracts. Main Line Health is a not-for-profit health system servicing Philadelphia and its suburbs.
The solution is a customized application of Mathematica’s Health Care Price Transparency Dashboard, which contains high-quality, organized, pricing data from national and regional health plans. Enhanced by built-in linkages to more than 20 external data sets, the dashboard enables providers and health systems to analyze case-mix-adjusted reimbursement rates with high precision. It is updated regularly to ingest plan price information and new plan files. Visualizations are built using Amazon QuickSight to ensure data housed on Amazon Web Services can be easily interpreted and are ready to use.
“Hospitals have had little access to information about how much insurance plans pay other hospitals in the market for the same services,” comments Evelyn Li, senior researcher at Mathematica. “This information asymmetry puts hospitals at a disadvantage in contract negotiation and leads to wide variations in prices that hurt consumers. By equipping themselves with accurate and complete reimbursement data, hospitals and health systems can transform contract negotiations with payers and help promote a more efficient health care market.”
The custom solution includes access to analysis-ready data covering negotiated prices for hospital inpatient and outpatient services from each insurance plan in Main Line Health’s surrounding market.
“With this data, we can now assess relative prices for specific services and clinical categories across hospitals and health plans in our market,” said Dana Rainey, associate vice president of payor strategies at Main Line Health. “Insights from this data will strengthen our strategies around rate negotiations and identify value-based care payment opportunities.”
Learn more about Mathematica’s price transparency solutions for health systems across the country.