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Closing the Gap: Bridging the Price Transparency Divide between Healthcare Entities and Standard Formats

  1. April 19, 2023
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Price transparency in healthcare has emerged as a top concern, with the healthcare industry facing skyrocketing costs, complicated pricing structures, and new legislative efforts. Neil Larson, Director of Data Services at Benefits Science Technologies (BST), shed light on the topic and highlighted how BST is leading the charge with innovative solutions.

How has price transparency in healthcare impacted the healthcare decision space?

Price transparency in healthcare and coverage has been a game changer in how the healthcare insurance ecosystem will function. These prices have never been publicly available. Ever.

It has caused a giant black box in nearly every business and has frustrated a number of players in the space.

With price transparency in healthcare available, it can really change how decision-makers approach their contract negotiations, network strategies, and care focus and, I believe, allow employers and households to make informed decisions about who provides the most efficient and effective care.

What changes have increased transparency caused when delivering data science as a service?

In the data science as a service space, healthcare professionals need easy-to-use, curated key information as they negotiate contracts.

Our philosophy at BST is that it’s not enough to make the data available. Plenty of warehouses are available, and plenty of companies will try to wrangle the data. The critical difference is that BST brings together computer science, data science, actuarial science, and industry expertise to build a solution that will meet the decision-makers where they’re actually trying to take action.

BST’S Panorama

What is BST creating to provide price transparency solutions?

It’s our Panorama product suite. It asks, “How do we meet customers where they’re trying to make decisions?”

That fundamentally comes from our MIT heritage, where we were experts at managing data and modeling, but at the end of the day, the decisions that must be made matter. That data should be used to power decisions and make the customers’ lives easier.

That’s our area of our focus. We’ve had innovative breakthroughs on how to acquire the data, transform it, normalize it, and bring it together, which is massive.

Our computer science team is making life easier for customers with breakthroughs in managing, housing, and indexing this data.

What comes next for Panorama?

Our focus is building products and software on top of the data to make it useful. The next step is the product roadmap. We have search available, now. We’re also building tools for payers and carriers to support their contract negotiation and network build-out – what we call Network Optimization.

We’re building products to support providers in their contract negotiations – helping them understand where they sit in the market and find answers to questions they’ve never had answers to before.

We’re working on products that help employer consultants make critical decisions about the best network partners. If they have their claims data, we can use it to give insights into who has the best financial profile to support them.

What problem will Panorama solve in the industry?

One of the fundamental problems BST aims to solve is the lack of experienced financial or data analysts. With all the data flowing through the healthcare and healthcare insurance space, there are just not enough experienced financial analysts or data analysts to tackle it and provide meaningful insights. It’s an overwhelming problem.

BST steps into that gap, providing decision-makers with the answers they need.

How will Panorama make life better for users?

With the search tool, users can get into the nitty-gritty details, diving into the weeds at a granular level – that’s valuable. Whether it’s for claims audits or market selection, there are a lot of different entities that could benefit.

Moving forward, Panorama will be a seamless and intuitive platform – a web application where users can find the answers they’re looking for.

Carriers may want to know what other carriers to compare themselves against, what providers are talking about, or where they should focus. Panorama will give them control to find those elements and provide summary results they can implement immediately.

Similarly, providers may want to know other providers who serve similar customers in their area. If they’re a cardiologist, they need to know other cardiologists near them who treat similar conditions. With Panorama, they’ll be able to answer those questions while focusing on a particular network at one time, in an environment where they can easily automate and control key elements.

How can BST clients leverage the data provided by Panorama?

Knowledge is power. If somebody doesn’t know the pricing structure in their market or what other people are getting paid, there’s a good chance that they’re being taken advantage of, which happens on both sides of the equation.

A large insurance carrier may have had a dominant market position and not know that it’s being eroded, where competitors are finding a way to knock down prices. As a provider, the same elements apply.

Price transparency in healthcare data is the key to knowing and understanding so users can run their businesses more effectively.

In healthcare spaces, there has been a huge blind spot because price transparency data has never been publicly available. That’s changing. But somebody has to manage that data so they can use it to run their business efficiently. That’s where BST comes in.

Elements are missing from the raw MRF data. It takes expertise, data, and a real determination to bring all that together and to help people use it. In its standard format, I would expect 99% of healthcare or health insurance entities couldn’t use it, and that’s why we’re bridging that gap.

How is BST working to bring price transparency in healthcare data to market?

With any new opportunity, there’s an attitude of speed to market. That’s crucial, and we’re working fast, but there also has to be a conscientious, deliberate approach to make sure what you’re looking at is meaningful.

It’s easy to misinterpret healthcare claims and this data requires a diligent approach to ensure results are meaningful.

We’re committed to stress and effective quality control testing using our expert resources, to ensure Panorama will be the most robust product on the market.

About Neil Larson

Larson has been with BST for five years. Prior to joining BST, Larson spent most of his career in actuarial consulting, working for Hewitt and Blue Cross Blue Shield of Texas before moving to Gallagher. While at Gallagher, Larson discovered BST and eventually became a customer before joining the company as an employee.

As the Director of Data Services, Larson is ultimately responsible for solving customer problems. He ensures BST delivers to nine different market channels.

About Benefits Science Technologies

BST offers data analytics software and analysis to manage risk for self-funded health plans effectively. By improving plan holders’ access to data, optimal decisions can be made to control costs and improve the quality of care for plan members. BST’s capabilities are distributed through direct employers, brokers/consultants, and partnerships with carriers, benefits administrators, professional employer organizations, third-party administrators, pharmacy benefit managers, and cost-containment providers.

Established in 2012, BST is a world-leading research and applied science team that develops advanced analytics and robust optimization methodologies for complex health insurance decisions. BST’s mission is to improve health outcomes while reducing costs by providing actionable insights and outcome predictions based on the details of clients’ health plans. BST’s strategy is to develop world-class solutions based on the latest scientific insights.

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