Assessing the Usability of Insurance Payment Rate Data Under the Price Transparency Rules: A Case Study of Ohio Mental and Behavioral Health Services

OBJECTIVES:

A goal of price transparency regulations is to lower societal costs and enable providers to benchmark the prices of their services. On July 1, 2022, the United States (US) government required insurers to publish their negotiated rates by service provider. Providers may use this information for negotiations and the public may benefit from lower prices due to transparency. The objective of this study was to assess the feasibility of accessing and utilizing this information in mental and behavioral health services in Ohio.

METHODS:

Payment rates for Anthem Ohio PPO (Anthem) and Medical Mutual of Ohio SuperMed (MMO), were downloaded on November, 2022. The data were imported and synthesized into one file using python and organized by unique employer identification number. Variable names were cross-walked between the files and standardized. Mental and behavioral health professional services were identified by CPT codes. Data were imported into Tableau and dashboards created to explore and summarize the data. Summary statistics by plan, CPT, place of service, negation type, and billing arrangement were generated.

RESULTS:

There were 104,883 payment observations (99.3% MMO) for 14,793 unique providers in Ohio. Mental and behavioral office payment rates comprised 78,357 (74.7%) of the observations. The most frequent CPT codes were 90832, 90834, 90837 – Psychotherapy W/ Patient 30, 45, and 60 minutes – which comprised 54.1% of the observations. Group Therapy, CPT 90853, comprised 8.1% of the observations. The median payment rates were $52.37, $73.43, and $108.41 for CPT codes 90832, 90834, and 90837. The median payment rate for group therapy was $17.24.

CONCLUSIONS:

The insurer negotiated rates are available for public consumption. However, the resources and technology required to use the data to inform decisions is currently beyond most providers in the mental and behavioral health.