Turquoise Health recently announced the release of its Payer Transparency Scores and Impact Report. The new publicly available dashboard and report evaluate the quality and completeness of machine-readable files (MRFs) published by insurers, offering the first standardized way to assess payer-reported data’s completeness and usability. The report builds on the dashboard, offering a State of Price Transparency today, surfacing insights across payer score, national payer specific analysis, policy updates, and more.
With this release, Turquoise shifts the conversation from “what files and rates are posted?” to “what files and rates are complete, accurate, and useful?” Reporters, analysts, hospitals, and payers alike can use the scores to understand how insurers are performing on transparency, where gaps remain, and where the highest quality is, saving time in analysis. Payers can use the scores to improve the quality and accuracy of their own files, exploring performance on an individual hospital/ASC basis. For Turquoise’s own analysis on the scores, the Impact Report surfaces themes across payers and score criteria.
Payers are first evaluated on three key measures: parsability, or whether files can be processed; conflicting rates, where multiple rates are reported for the same procedure with no way to distinguish them; and outliers, rates that fall outside expected ranges. These inform each payer’s actual scores. Hospitals are scored across inpatient and outpatient categories, while ambulatory surgery centers (ASCs) are scored on surgical and EAPG codes. Results are rolled up from provider to state, and then to an overall payer score, translated into qualitative grades of Excellent, Good, Fair, Poor, or Missing.
Payer Transparency Scores and the Impact Report build on Turquoise Health’s continuous work ingesting and structuring terabytes of payer files each month. This effort showcases Turquoise’s unique vantage point on the industry and its ability to evaluate payer reporting at scale and support payers in creating high-quality, robust files. Both the scores and the report highlight best-in-class examples and areas where files fall short, providing hospitals, analysts, and payers with a clear, objective measure of data quality. The scores cover the top 100 payers nationwide, representing the networks most reflective of each payer’s overall dataset. Payer Transparency Scores will refresh monthly, through a public-facing interface.
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