Health Prices Toolkit

A new claims grouping tool that produces easy-to-understand price benchmarks for health care services. More than 350 bundles are now available.

What is the Toolkit?

The HCCI Health Prices Toolkit is a grouper methodology for calculating low, average, and high prices for “service bundles” using facility and professional claims, addressing transparency issues.

STEPS are comprised of one or more services or procedures identifiable in claims data.

BUNDLES are comprised of one or more “steps” that summarize treatment, care for a common illness, condition, or other medical encounter.

MAJOR STRENGTH

The Toolkit Helps Consumers Understand Price Variation

Price transparency results from the Health Prices Toolkits can:

  • Help patients and purchasers understand the expected cost of care

  • Identify high- and low-value providers

The output from the Toolkit reports a low, average and high price for each step and bundle.

The bundle prices are the sum of the step prices within the bundle, making it easy to highlight which parts of care are driving the price of the overall bundle.


EXAMPLE BUNDLE

Step 1

$195 Avg

Evaluation

A visit with a health care provider for a detailed evaluation and treatment of your symptoms.

Step 3

$1,025 Avg

Physical Therapy

A guided exercise program to reduce stiffness and improve range of motion in the knee.

Step 2

$24,683 Avg

Surgery

Surgery to replace a diseased or damaged knee joint with manmade parts.

Step 4

$212 Avg

Post-Op

Follow up office visits and x-ray after you have left the hospital.

How Does the Health Prices Toolkit Work With Your Current Software?

The Toolkit is built around two lookup files and four SAS programs. It does not require installing additional software in your data environment.

The Toolkit includes a user guide with detailed instructions for creating the input files and running the SAS programs.

The output from the Toolkit is two CSV files that can be read into other programs for analysis and reporting (e.g., Excel, Tableau, R, Stata).

MAJOR STRENGTH

Simple Implementation

Price transparency results from the Health Prices Toolkits can:

  • No need to install proprietary software

  • Input data via CSV file and run the included SAS programs to output CSV files that can be read by most analysis and reporting platforms

  • A detailed user guide is included

The Toolkit Differs from Other Groupers in Two Unique Ways

1

A focus on service prices, rather than episode costs

2

Not reliant on individual patient identifiers

An Additional Perk for Health Prices Toolkit Users

Access to benchmark data from HCCI’s Employer-Sponsored Claims Database for understanding how prices in your data compare to metro-area, state, or national benchmarks.

Put your data in context by comparing it to prices derived from more than 400 million claims from 50 million covered lives.

Contact our team to purchase the Health Prices Toolkit