Recently, Turquoise Health CEO Chris Severn laid out his multi-year vision on how healthcare pricing transparency data can change this historically slow-moving industry. While your newsfeed may be full of multi-billion dollar health systems or payer behemoths, there’s one group of providers and payers that are quietly helping speed up the massive transition to transparent pricing: regional and community hospitals, insurance companies, and speciality clinics. Like any political movement or the process of becoming a chess grandmaster, healthcare starts local and expands as it grows or gains momentum.

Let’s take a moment to contextualize these regional and community organizations within the larger healthcare transparency landscape. We’ve spoken at length about the time- and resource-intensive process of dissecting transparency files, and regional or local healthcare entities may not have teams of data scientists to parse through publicly-available pricing data. Their analytics “department” may be composed of a few employees actually working for other departments who, if asked if they love pivot tables or VLOOKUPS more, would respond, “That’s like asking me to pick a favorite child!” Like any organization working to maximize employee resources, the primary focus is on core business needs and maintaining quality clinical care. As a result, these organizations are scrappy and resourceful, often seen as crucial incubators of change in the industry. Regional and community organizations are willing to experiment and trailblaze because they’re more nimble and stand to gain from targeted insights that move the needle on process improvement and profitability. So the landscape is an optimistic one: inventive, savvy organizations and publicly-available price transparency together for the first time.

It’s nearing the end of 2022, and many folks expected rate updates and slashed prices that have not come to fruition yet. What gives? Part of why so many businesses and consumers are eager to see material impact from the recent rules and laws is because public pricing data represents a transformation in American healthcare. In reality though, the first few iterations of pricing data offered users inconsistent formatting in hospital transparency files and payer files roughly the size of Neptune* that have quickly become roadblocks to gleaning impactful insights. The files weren’t an immediate silver bullet to clear prices and fewer surprise bills. At Turquoise, we believe the path to eliminating those roadblocks and achieving true industry transformation starts with simplicity. The basic idea: most upstart healthcare organizations only need a very specific slice of the massive payer file pie. Slices could be for a rural hospital that needs charges and rate data on common billing codes, or a surgery and/or imaging center wanting to focus on favorable pricing as part of local market dynamics, or an Autism/speech therapy center that needs commercial payer rates for five therapy CPT codes. These scenarios, and many others like them, led us to create Simple Extracts, which is a product built for pulling the right needles out of the right haystacks (emphasis on plural…this ain’t one haystack, folks, it’s a whole field of them. And yes, I am from Indiana.).
*statistic not confirmed by the Turquoise data team

If exploring the hospital data released in early 2021 required resources for a successful quick weekend hike with a few unexpected rain showers, successful payer data exploration in July of 2022 required resources for an expedition to Antarctica. After four and half months of hard work on the frozen tundra of payer data, we’ve reached a point where any upstart organization can ask for a specific list of codes in a geographic region for specific payers and receive the data they need from the comfort of their own home…no coats or winter gear required. We’ve seen the impact of payer data reach specialty clinics focused on autism and sleep, upstart medical device companies, and others to continuously improve the functional utilization of the massive payer dataset. If you want to request an extract, you can do so here.

One of those first transparency data trailblazers was Hector Bruno, the Executive Director of Sleep Net PR, a sleep center based in Puerto Rico looking to expand into Tampa. Hector’s mission was simple: extract pricing and rate data for a handful of specific sleep related codes in one market of Florida. On his own, this would require digging through terabytes of JSON files and data. With Simple Extracts, this required filling out an online request form and then getting back to work. The results allowed him to zero in on exactly what he needed to make strategic business decisions and avoid all other noise. The results spoke for themselves and for future patients in Tampa having trouble getting their full 8 hours of rest:

With the help of Turquoise we were able to finalize our plan to open a sleep lab in Tampa. Without Mark Slifer and his team, we would never have been able to obtain data and fee schedules from payers and providers quickly and reliably. Now we know the market and we can position ourselves competitively.” - Hector F. Bruno, Executive Director Sleep Net PR.

Access to meaningful data moves us along the path of transformation, but we’re not to the finish line yet. The price transparency rules have additional layers of requirements for calculating patient estimates, so we expect users to leverage the data beyond market analysis and into the process of creating estimates. Clearly-understood transparency data becomes the backbone of accurate estimate calculations, which can be turned into positive and straightforward patient experiences.