Real-Time Payer Rates Data Tracker

If you're a real healthcare nerd, you may be spending the July 4th weekend looking out for machine-readable fireworks vs. the colorful types in the sky. If so, you're in the right place. Payer data is coming out with a bang, and Chris and Adam (cofounders of Turquoise) are here to share what we're seeing live, as it happens.

Let's dig in.

Last updated 7/15 5:50PM EST

7/15 5:50PM EST

A few more maybe interesting stats about parsed data:

  • 588 distinct report_entity_names (often, this is the carrier, but this can also be the TPA or plan sponsor)
  • 220,000 distinct "plan_name" and "reporting_entity_name" combinations (eg):

7/15 5:46PM EST

A few high level stats to end the week. For those familiar with the CMS schema pertaining to the payer data, we have parsed:

  • Over 400,000 unique combinations of reporting_entity_name, plan_name, plan_market_type, plan_id and plan_id_type. This inflated number is driven by many small employers and slight difference in plan_id. The actual number of unique networks (and carriers) will be much smaller, but still significant:
  • 2.8 billion in network negotiated price objects. Since there are also billions of provider references these map to, the two of these together make for...a lot...of unique negotiated rates.
  • Over 700,000 unique files downloaded and found. Many of these are Humana (they cut the steak into tiny pieces instead of serving up a t-bone).
  • Much more in the in network files vs. the allowed amount files. We've just started to explore the allowed amount data though - I imagine the smaller amount of data is due to more fully insured plans driving the rates (keep in mind, payers only had to disclose services that occur > 20 times with a provider in a 90-day period). Here's a snapshot w/ one therapy code, not at provider level:

7/15 5:28PM EST

It's time for an EOW update, and what a week it was. We have a slew of highlights coming this afternoon, in no particular order.

We've parsed all of Anthem (or, ahem, Elevance). What's more interesting, is we've parsed several different pizza companies' rates. Now the question is = which pizza company has the winning mix of "most tasty pizza" and "most affordable negotiated rates?"

A slice of pie and an affordable colonoscopy, please

7/11 9:49PM EST

It's another Monday in paradise. A few observations from a weekend filled with crunching payer data for the sake of #transparency:

  • Gotta love the fine folks at AWS checking in on us today:
Like a good neighbor, AWS is there

It's OK, AWS! It's for a good cause. This is like when Chase reaches out to me and asks "was it really you that just ordered that much pizza?" We did have 200+ servers running today in unison working their way through payer parsing.

  • We sip coffee and watch this page update. I wish we could make this page public for all to watch as our server army gobbles up MRFs:
That's a whole lotta objects
  • We've gotten a lot of questions around timing & total coverage ("what % of payers have posted?" or "when can I see all payer rates for CPT 99213?" and "is the data in these files actually any good?"). We're excited to keep answering these questions in this blog. At Turquoise, rather than parsing one-off files and analyzing them, we're going with a "parse all (or most) of them first" mentality. We will have a massive, queryable warehouse shortly for our customers (days, not a week) & start spittin' broad facts on this blog soon after.
  • We will release a sample dataset to this link in the coming week. Happy to take requests on the ideal non-commercial/academic data subset, as long as it's not "freebird" or "don't stop believing" -- https://turquoise.health/researchers
  • Until then, this gif mostly describes our data engineering team at the moment:
Live video of Adam Geitgey

7/8 2:23PM EST

As we continue the task of ingesting, processing and loading payer rates to our database, we figured we'd pause momentarily to provide you with this highly satisfying map. Each dot on the map represents a provider practice location in which a payor has reported rates for. Over the course of the next week or so, we anticipate much less whitespace as all the BUCAH rates are loaded.

7/7 11:47AM EST

Have you also been patiently waiting the past 18 months for some line of sight over ASC rates? If so, look no further! It's now entirely possible to view the negotiated rates between a payer and an ASC, and to also compare those rates to what hospital outpatient departments are paid for the same service. Pretty cool, huh?

7/6 5:05PM EST

Miss us? We were busy guzzling payer data the past few days, but now we're back with updates. This week and next, we'll be chiming in on what we're seeing in the data now that we have 500TB (uncompressed) in payer data sitting in our cloud, waiting to rock and roll American healthcare. That's right - even the BUCAHs + Centene are all online, and that's big.

Over the next two weeks, we'll bang pots and pans and make noise about the payer data contents. On the topic of pots and pans, Tramontina (maker of pots and pans & a self-insured employer) has useful data on their website, such as:

  • Return policy
  • How to remove the ice maker cover
  • Cigna rates at thousands of provider locations

7/2 2:30PM EST

Some smart people have pinged me in the past 24 hours asking "so what are you going to do with all this data?" Believe it or not, we do have bigger plans than live blogging and making jokes.

We're actively ingesting all this data into our data warehouse so that YOU, dear reader, can access it easily for analysis. We'll also be piping this steaming hot data into our public site for patients to browse for free. These are July things that we'll be rolling out day by day - not like, sometime next year.

7/2 2:05PM EST

Feeling some Saturday blues? Same - just added Blues from Hawaii, Minnesota, Mass, Michigan, Montana, California, Texas, Penn, and Nebraska to the database. Generally, hats off to Blues plans nationwide for the timely data (I truly did remove my hat for this statement).

7/1 9:02PM EST

Day 1 mostly in the books. Supposed to be at a wedding right now but really hard to leave these parties raging on payer websites.

Non-exhaustive inventory of the day - about 100 large carriers with files found. These extend to (and reference directly) thousands of self insured employers & tens (if not hundreds) of millions of Americans. Time to let the MRF monster eat. Have a nice evening, healthcare people.

7/1 6:32PM EST

Jones Dairy Farm in Fort Atkinson, WI offers breakfast sausage, ham, bacon and discounted in network rates through Dean Health. Mmm, mmm good. (Also, Dean Health is a website we're seeing some late-day action on. I'm sure there are lots of healthcare IT folks tapping their feet and ready for the long weekend).

7/1 4:45PM EST

Winner for the best Turquoise home-grown meme of the day. We're working hard but having fun here.

Credit to Tess N, Sales Engineer:

7/1 4:40PM EST

Still crickets from Aetna, but every indication looks like they intend to comply. Maybe they're going for July 4th launch in true American spirit.

7/1 4:30PM EST

Premera's MRF hub let's you search for big employers like Blue Ribbon Linen Supply, Microsoft Corp and Amazon (one of these is not like the other). Cool!

7/1 12:07 PM EST

Memorial Hermann HP - like provider, like payer:

7/1 11:45 AM EST

The west coast morning shift is taking over with a fresh cup of coffee.

United Healthcare (have you heard of them?) has files online, but their Table of Contents files are a bit wonky and there is some site instability. We're giving these a little Turquoise elbow grease to get them ingested into the MRF monster.

7/1 8:16 AM EST

Anthem (Blue Cross) has posted data for California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, New York, Nevada, Ohio, Virginia, and Wisconsin. Just the index file listing all the other files is 7.65GB!

We are as excited about data as the guy they have on their website:

7/1 6:10 AM EST

Lots of files posted from Blue Cross Blue Shield state-level operators! We've pulled in data from BCBS Kansas, BCBS Louisiana, BCBS Mississippi, Horizon (BCBS New Jersey), Regence (BCBS Washington, Idaho, Utah and Oregon) and Capital Blue (BCBS PA).

So far, BCBS seems to have done a pretty good job posting data. A special shout-out to Regence for offering the option to download all the data for a state or the ability to search for a specific plan ID or specific employer!

7/1 4:19 AM EST

Cigna has also posted rates. But they decided to go with the comically complex option of asking users to cut and paste a link instead of just making it a normal link:

7/1 3:32 AM EST

Lots of data is going live now that it is officially July 1st.

Kaiser Permanente and BlueAdvantage Administrators of Arkansas are some of the first:

6/30 9:14PM EST

Sanford Health Plan in South Dakota is live. Sanford is among many health system-affiliated health plans - it will be interesting to see the pricing dynamics of these plans vs. traditional carriers.

6/30 6:42PM EST

"Pilgrims weren't the first to land this time - but close!" - Ryan Kost @Turquoise

6.30 4:41PM EST

A lot of payers said publishing these files would be really tuft. In other news, Tufts Health Plan is live & super employer specific. I've highlighted the Berklee College of Music file just because it strikes me that a lot of music students would care about saving money on healthcare.

6/30 3:50PM EST

As expected, we're starting to see large national payers pop up on affiliated health plan websites. I spy Cigna! (Sit back and grab some popcorn while that 584GB downloads).

6/30 11:53AM EST

Looks like CareFirst is leaning heavily into the Table of Contents method of hosting these MRFs. In many ways, this is much easier for a user looking to download just the data for a specific plan.

6/29 1:11PM EST

It looks like Humana may be one of the first large payers to come online. 440,000 sweet sweet csvs. While csvs are not an acceptable format per the CMS guidance, it does look like these files contain a wealth of rates data and are relatively logical. It's reassuring to see a large payer post this quickly, albeit in an unexpected format. BTW - Some quick back of the envelope math - that's about 20TB of data!

Will be interesting to compare this payload with other large payers posting shortly.

6/28 11:38 AM EST

We've been curious to see how self insured employers will post these MRFs (as they're required to by TiC). Lockheed Martin is an early sign of one way employers may comply: a link on their website which leads to a Castlight (third party transparency company) page, which then links out to all the carrier pages that Lockheed employees use. It's like a scavenger hunt for healthcare nerds.

...leads to....

...leads to...