INSIGHT #1: MAY 2023
From Many to Few: Making MRF Data Usable
Blue Health Intelligence® (BHI®) recently completed a proof-of-concept project with the Blue Cross Blue Shield Association with the goal of comparing Blue Plan provider networks in five markets against those of Aetna, Cigna, and United Healthcare.
In those five markets, there are 147,824 distinct plan identification number and name combinations.
BHI’s data science and analytics team created a robust machine learning methodology to “flatten” repetitive networks, allowing for tens of thousands of different plans to be represented by 167 common networks and reducing data by more than 99%.
Plans are now empowered to analyze comparable provider rates and coverage for networks that matter most.
Combined with Blue Plans’ claims experience, Transparency Analytics can help Plans quickly identify services, providers, or regions of opportunity. This facilitates rate comparisons between competitors’ provider and service networks, helping Blue Plans understand their competitive advantage.
INTENDED FOR BCBS USE ONLY. DO NOT SHARE OR DISTRIBUTE EXTERNALLY.
Insight #4: Using MRF Data to Competitively Price Telehealth Services
The end of the COVID-19 public health emergency means some states will not require payment parity for telehealth.
Insight #3: Optimize Reimbursement and Pricing Strategies with MRF Data
Enriched MRF data helps Plans uncover pricing discrepancies and opportunities for rate renegotiation at the DRG category- and service-level.
Insight #2: Use MRF Data to Uncover Blind Spots in Your Network Strategy
Machine-readable files (MRFs) offer Plan leaders the ability to understand real-time market positions – before they begin network negotiations.
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