Overview
Unlock Strategic Advantage with HSG Advisors’ Price Transparency Analytics
Health systems are under increasing pressure to maximize reimbursement and safeguard financial health. Yet, many organizations lack visibility into how payer reimbursement truly varies—internally and across the competitive landscape.
HSG Advisors’ Payer Transparency transforms this complexity into clarity by delivering powerful, actionable insights that reveal hidden reimbursement patterns and uncover opportunities for strategic improvement. Whether you’re aiming to benchmark against peers or optimize internal performance, HSG equips you with the intelligence to lead with precision.
How We Work
The Challenge: Hidden Variation in Reimbursement
Health systems often encounter significant pain points when managing payer contracts and reimbursement:
- Opaque Internal Variation: Reimbursement rates for identical procedures can differ widely across payers and even across sites within the same system, making it difficult to benchmark performance or identify underpayment.
- Market Inconsistency: Competitors may secure higher rates for the same services, leaving health systems at a disadvantage in negotiations and financial planning.
- Limited Negotiation Leverage: Without clear, data-driven evidence, health systems are forced to rely on anecdotal information or payer assertions, weakening their position in contract discussions.
- Missed Revenue Opportunities: Unaddressed reimbursement gaps can result in substantial lost revenue, especially when organizations are unaware of how their rates compare internally and externally.
HSG Advisors’ Payer Transparency empowers health systems with a comprehensive, data-driven understanding of payer reimbursement dynamics. By integrating payer-posted and hospital-posted machine-readable files with proprietary service line definitions and national NPI mappings, HSG delivers customized analytics that reveal both internal and external variation.
- Internal Reimbursement Benchmarking HSG analyzes professional fee yields as a percentage of billed charges across multiple payers, enabling clients to:
- Benchmark performance at the procedure level: Identify where the organization may be underpaid relative to peers within its own system.
- Spot strategic gaps in payer contracts: Focus on high-volume or high-acuity services where reimbursement is lagging.
- Support data-driven negotiations: Use granular CPT/HCPCS-level comparisons to prioritize renegotiation efforts where the financial impact is greatest. This level of detail allows health systems to isolate specific codes and compare across payers, ensuring that renegotiation efforts are targeted and evidence-based.
- Competitive Market Comparison. HSG’s analytics also enable health systems to compare their rates against competitors in the market:
- Demonstrate market inconsistency: If a competitor is paid significantly more for the same procedure, it raises questions about payer equity and consistency.
- Justify rate increases: By aligning quality metrics, patient acuity levels, and service delivery standards with those of higher-paid competitors, organizations can argue for comparable reimbursement.
- Strengthen payer discussions: Move negotiations from anecdotal to empirical, using real-world data to advocate for fair compensation. This approach is especially powerful when paired with internal quality data, patient outcomes, and service line performance metrics—creating a compelling case for rate adjustments.
Strategic Benefits and Deliverables
With HSG’s Payer Transparency, health systems gain:
- Excel-based reimbursement reports segmented by site of service, specialty, and location.
- Tableau-powered dashboards with 24/7 access to updated analytics and visualizations.
- Integration of price transparency data into existing HSG products such as Patient Share of Care and State-Level Market Share.
These deliverables support ongoing measurement, management, and strategic planning, ensuring that health systems can continuously monitor reimbursement variation and act on opportunities for improvement.
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