Where can we find data on value based care arrangements (e.g., case rates, bundles)?

The CMS price transparency schema does include explicit designations for capitation and bundled reimbursement arrangements. You can search these arrangements exclusively by utilizing filters on the arrangement field.

However, through research, we have noticed that case rates are not always labeled explicitly. For example, one imperfect heuristic for identifying case rates in the data is looking for rates that (a) have no decimal points and (b) apply across several codes for a given EIN. For example, if an EIN has the same $300 rate across a range of E&M visit procedures, it is likely they have a case rate arrangement with a payer.

Additionally, we have seen case rates appear under case management codes. For SUD companies, for example, these are G2086, G2087.

For more detail, please check out our blog here: https://www.serifhealth.com/post/seeing-value-based-contracts-in-the-payer-price-transparency-data