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In a recent interview with Managed Healthcare Executive, Matt Parker, Vice President of Product at Kyruus Health, discussed the newly implemented price transparency rules. The rules involve three milestones, starting with machine-readable files (MRFs) containing negotiated rates for healthcare services. Initially intended for researchers, these files will be integrated into a self-service tool for health plan members by January 1, 2023, covering 500 shoppable items. By 2024, plans and payers must extend this capability to all covered services.

Parker believes insurers are more motivated to comply due to higher penalties compared to hospitals. Many hospitals weighed the cost-benefit of compliance against penalties, making selective choices. In contrast, the majority of the 100 health plans Parker works with express intent to comply. Transparency is crucial for insurers, constituting a significant part of member services. Parker notes that 88% of people expect payers to provide transparency, differing from the hospital context. Lack of price information influences care decisions and can impact downstream costs, emphasizing the importance of transparency for both payers and members. Most insurers already have transparency tools in place, making this an evolution rather than a new offering.

What the interview below.