Health plan network discounts have become the number one financial metric that insurance consumers—namely self-funded employers and brokers—rely on to determine the lowest-cost option when selecting their carrier of choice. 尽管报告健康计划的网络折扣是自愿的, it is often a necessity if you want your plan to even be considered during a request for proposal process—and the results of a carrier’s reported discounts can have major implications on the ability to grow and retain business.
折扣报告.¹如UDS (Uniform Discount and Data Specification)流程所支持的, 对安泰等国家航空公司来说,结果总是非常有利, 国歌, 和UnitedHealthcare. 品牌价值, 市场份额, 网络规模可以让这些主要的健康计划获得较低的支付率, 他们还雇佣专门的团队,专注于优化(i.e.(策略性地选择)他们的索赔数据用于这些提交和随后的报告.
区域保健计划, 尽管有国家航空公司的优势, 有竞争的机会——为了增长或保持市场份额,他们必须有竞争的机会. Smaller health plans can enhance and accurately report their network discounts by adopting advanced data analysis and optimization strategies. This could significantly improve their competitive positioning and mitigate the dominance of national carriers by showcasing their own cost-efficiency and value to consumers.
下面, we outline the complexities associated with UDS submission and highlight the strategic considerations health plans need to make to optimize their participation and accurately represent their value proposition. We also discuss the use of price transparency data to counter the UDS results (or supplant them entirely) and the additional benefits of utilizing this information.
UDS流程简介
UDS has become a standard data submission process in the healthcare industry to analyze provider network discounts. Participating health plans submit most—but not all—of their claims data set to insurance brokerage firms. 这些意见书是按住院病人的云顶集团类别整理的, 门诊, 和专业, 具体包括费用, 协商允许金额, 和地区.
这些数据允许经纪人按云顶集团类别和地区按付款人报告网络折扣, 与市场上参与提交的所有其他健康计划相比. Its purpose is to provide a standardized set of metrics for stakeholders to evaluate the economic benefits of different health plans. These reports are frequently used by brokers to guide self-funded employers through the health plan selection process. Health plans that do not participate in the final report outputs are often neglected during these conversations.
虽然折扣指标很容易理解, UDS过程的简单性可能具有欺骗性, 掩盖医疗报销的复杂性,可能误导消费者. 提交没有得到适当的监管, and the lack of penalties for inaccurate or misrepresentative data submissions leaves room for interpretation and potential bias, 特别是主要的保险公司在很大程度上影响了规格. 扭曲的参与使情况进一步复杂化, 由于当地的健康计划网络定价往往似乎是不利的,但它很可能不是.
By thinking proactively about a long-term UDS participation strategy and intentionally investing in increased analytical sophistication, 健康计划可以优化其提交, 更好地代表他们的价值主张, 并将自己定位为产生新的指标来增加UDS数据.
UDS参与的战略考虑
考虑参与UDS的保健计划必须采取深思熟虑的战略方针. 虽然不参与可能不是许多计划的选择, participating and reporting unfavorable results may be even more detrimental to a plan’s membership growth and retention numbers.
决定是否参与, perform a thorough evaluation of your utilization data and contracted rates to assess how your current rates compare to market competitors. 另外, evaluate rate and reimbursement amounts from different angles to test the most accurate and transparent method of measuring market discounts, 这些测量结果可能比UDS报告的结果更有利.
最终,在决定是否加入UDS时,您的计划必须权衡以下几个因素:
- 长期参与. Has your health plan delineated its long-term strategy regarding participation in subsequent data submissions? 如果有,哪些因素会影响你的持续参与?
- 与福利咨询公司合作. 您的健康计划在提交数据时会考虑哪些福利咨询实体, 你的选择标准是什么?
- 探索额外的排除和调整. Is there a specific exclusion or adjustment your health plan wishes to investigate to refine its data optimization strategy? How accurately do these adjustments represent the discounts your health plan has negotiated in the market?
- 数据完整性和代表性. 你的健康计划如何保证这一点, 同时调整提交的数据, you maintain the integrity and representativeness of the data to accurately reflect performance and the value proposition?
- 法规和遵从性考虑. Are there any regulatory or compliance implications associated with your proposed data submission strategy that you should be aware of?
- 保持价格透明度. 价格透明度数据分析是否与以前UDS报告的结果一致? 结果对你的健康计划是更有利还是更不利?
- 可选指标和消息传递. 使用公开发布的价格透明度率和客户的群体利用率, would it be more advantageous to stop participating in the UDS submission and instead share the results of price transparency?
- 综合价值主张. 此外,定量测量网络定价, 你的信息和沟通是否抓住了你的健康计划的全部价值主张?
UDS流程参与决策树和其他选项
长期战略选择:以价格透明取代UDS
随着医院和付款人价格透明度数据的可用性, health plans and other market stakeholders now have the ability to measure and compare network pricing among market participants. The price transparency files contain actual negotiated rate information necessary to determine the actual per unit costs for facility 和专业 sites of service. 公开的价格透明度数据有可能更加准确, 及时的, 比UDS透明.
此外, health plans can apply price transparency to group utilization data to calculate the group’s service-mix-specific network costs. 这可以更准确地反映一个群体在市场支付者之间的医疗云顶集团成本. 另外, developing a model to analyze price transparency data will inherently include group-specific utilization information that can enable more granular insights such as pricing differences by health system, 地区, and even service category—which can be highly valuable in growth strategies that target specific groups and their stated priorities.
化挑战为机遇
总之, UDS进程, 而一个历史和广泛使用的基准评估健康计划网络折扣, 为健康计划带来了挑战和机遇. 国家航空公司利用他们的规模和专门的分析团队来优化他们的提交, 常常使地区玩家黯然失色. 然而, the investment in advanced data analysis and optimization strategies offers 地区al health plans a viable path to improve their competitive positioning and accurately report their network discounts. 战略考虑——包括长期参与, 数据提交的改进, and an understanding of price transparency—are crucial for health plans to accurately represent their true network value proposition.
通过采纳这些策略, 健康计划可以提高透明度, 确保数据完整性, 并更好地向利益相关者传达他们的综合价值主张, 可能会使竞争格局朝着有利于他们的方向转变.
希望优化您的健康计划的UDS参与? 云顶集团的付款人云顶集团团队.
¹Reports are produced by health insurance brokerage firms by aggregating discount data submitted by participating insurance carriers in a given market.
编辑:Matt Maslin
出版于2024年5月28日