Our workgroup has come together to determine how the private sector can collaborate to develop consensus on technical and definitional frameworks for implementing price transparency regulations. These regulations include the CMS Transparency in Coverage Final Rule, Hospital Price Transparency rule, various components of the No Surprises Act, and the Real Time Drug Pricing regulations. The ultimate goal is to empower adopters of the price transparency regulations (payers, providers, technical implementers etc.) to produce outputs that are consumer-usable.

10 Provisional Service Packages

Code Description
29888 Knee arthroscopy ACL repair
19083 Breast Biopsy
45385 Colonoscopy / Removal of polyps or growths of large bowel using an endoscope
55866 Surgical removal of prostate and surrounding lymph nodes using an endoscope
42820 Removal of tonsils and adenoid glands patient younger than age 12
58558 Hysteroscopy with biopsy
55700 Prostate biopsy
43239 Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope
45378 Diagnostic examination of large bowel using endoscope
63030 Surgical procedure to decompress herniated vertebra

Our Members

“HCCI, PACES, and Turquoise Health collaborated to create our initial 10 GFEs. Their work was endorsed by other leading health organizations, including Mass General Brigham and Porter.”

Updates

November 3rd, 2022: Helping to Lift the Veil on Healthcare Prices

Project Clarity announced a draft set of open provisional service packages to offer voluntary technical and definitional frameworks for implementing price transparency regulations made by the Centers for Medicare and Medicaid Services (CMS). While CMS’ price transparency regulations require both hospitals and payers to publish negotiated rates, there is a gap in the usability of this information, especially in developing “apples to apples” definitions for episodes of patient care, which would allow consumers to compare price and quality information across organizations.

Project Clarity published its first draft set of 10 episode definitions, which are presented as “open service packages” with their corresponding technical definitions for industry and consumer advocates to provide feedback. Through Project Clarity, the healthcare sector is collaborating on the front end of the healthcare continuum to create an integrated framework for a healthcare system that truly delivers on the promise of price transparency.

Lifting the veil on health care prices is one of the most patient-oriented reforms of the past half century. Requiring hospitals and health insurance companies to disclose what they charge unleashes competitive forces that drive down costs and increase quality. We have an opportunity to finally empower patients with the information they need to make more informed decisions, including prices for 500 ‘shoppable services’ – from maternity care to prescription drugs. Moreover, publicly posting prices helps transform American health care by accelerating the transition to the bundled savings model and value-based care.

– Seema Verma, former Administrator of the Centers for Medicare and Medicaid and Project Clarity Co-Chair

Op-Ed

New price transparency regulations for hospitals and insurers are a critical infrastructure for a consumer-focused delivery reform movement.In this recent STAT article, CareJourney President Aneesh Chopra and former CMS Administrator Seema Verma discuss the progress that’s been made on price transparency in healthcare—and the work that lies ahead.

Aneesh & Seema’s Blog

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