Challenges with effective price transparency analyses

(By Gary Claxton, Lynne Cotter, and Shameek Rakshit for The Kaiser Family Foundation published February 25, 2025)

This brief examines some of the issues and challenges researchers and other data users may encounter when using the price data reported pursuant to the Transparency in Coverage, or TiC regulation, promulgated by the Departments of Health and Human Services, Labor and Treasury (“Agencies”) during the first Trump administration. The regulation requires group health plans and health insurance issuers (“payers”) to make available, among other things, a machine-readable file with all of their in-network provider rates for covered items and services. Payers began releasing price data under the rule in July 2022, following an earlier requirement that hospitals report prices they negotiate with payers. From the onset, the complexity and extremely large size of many of the data files have made it difficult for researchers and many others to effectively gain access to the information. Over time, however, some organizations have become more proficient in downloading these data files and organizing the information for researchers and others to use. The discussion and examples in this brief use TiC data downloaded and maintained by one of those organizations, Turquoise Health. The challenges listed here are not caused by Turquoise Health; their aggregation of the data merely makes them more straightforward to identify. Continue reading here…

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