PBGH aiming for accurate pricing for employers with data project

The Purchaser Business Group on Health has announced the launch of a Health Care Data Demonstration Project.

The large data project is designed to make it easier for employers to determine what they're paying for healthcare.

The initiative, launched amid one of the biggest increases in healthcare costs for employers in more than a decade, marks the first time employers have had access to the data needed to compare what they actually paid for healthcare services against what they should have paid, PBGH said.

That allows them to pinpoint overpayments, challenge hidden fees and demand accountability from health plans and providers, the group said.

WHAT'S THE IMPACT 

The demonstration, conducted with five major employers – including Boeing, Qualcomm and the City and County of Denver – combines Hospital Price Transparency (HPT) and Transparency in Coverage (TiC) data with claims, quality and safety information.

The result is a set of tools that purport to reveal what constitutes a fair price – aligned with the fiduciary standard under federal law – and in some cases exposes the failure of third-party administrators (TPAs) and carriers to deliver value, the group said. 

Direct contracts, in contrast, demonstrated the best pricing and highest value, the group said.

Unlike All-Payer Claims Databases (APCDs) and other limited initiatives that simply show what was paid – often  without context, quality measures or the ability to identify specific plans or providers – PBGH said its model delivers actionable, employer-specific insights.

Employers can see how their payments compare to national commercial benchmarks, identify high-value providers and target the areas in which they’re being overcharged.

With employers facing steep increases in healthcare costs and under heightened fiduciary obligations enforced by the Consolidated Appropriations Act, the group said the demonstration provides a roadmap for how large employers nationwide can drive affordability, hold vendors accountable, design smarter benefits and push back against a system that has “thrived on opaque business practices.”

THE LARGER TREND 

PBGH will expand this service in the coming months, scaling it to more large employers, it said.

The year-long project was facilitated with support from strategic partners including Milliman, Embold Health, The Leapfrog Group and EY, and with funding and thought partnership from the Peterson Center on Healthcare. Together, the partners aggregated and analyzed claims, transparency and quality data.