Managed care plans typically hold all the cards when it comes to rate-setting. But a new way of analyzing billing data could finally give increasingly leveraged providers a better leg to stand on, financial experts say.
The new analysis breaks out the data by per diem rate, length of stay, revenue per admission, and outcomes per 30-day rehospitalization rate, as well as discharge to community rates for Medicare Advantage participants. It is based on 24,000 Medicare Advantage episodes during the half-year period ending Aug. 31, 2021.
The data provides benchmarks using managed care claims instead of fee-for-service claims and helps fill in a “black hole” of data, said Marc Zimmet, CEO of Zimmet Healthcare Services Group. It is the parent organization of CORE Analytics’ Medicare Advantage Post-Acute eXchange (MAPAX) program.