Frequently Asked Questions

The Employers’ Forum of Indiana is an employer-led health care coalition of employers, physicians, hospitals, health plans, public health officials and other interested parties. Our goal is to improve the value payers and patients receive for their health care expenditures. EFI is a nonprofit 501(c)(3) organization.

The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is a nonprofit 501(c)(3) headquartered in Santa Monica, California with offices in Washington, D.C., Pittsburgh, and Boston.

Sage Transparency 2.0 will use data from the Employer Price Transparency Study (PT5), conducted by RAND, to provide hospital, ambulatory surgery center (ASC), and medication price metrics. Hospital and ASC data represents the prices employers and insurance plans paid for health care as compared to what Medicare would charge for the same service. Medication data is represented as a ratio of the commercial prices paid for these medications versus the average sales price.

These studies are an ongoing employer-led initiative to measure and report publicly the prices paid for hospital care at the hospital level. They are the first of a kind in that it is an employer-led initiative that uses claims data to publicly compare hospital prices. The core goals of the study are to enable employers to be better-informed shoppers for health plans and provider networks and to report hospital prices relative to a Medicare benchmark.

View study comparison and national recognition.

The Employer Price Transparency Studies are funded through a combination of foundation grants and contributions from participating employers.

• RAND 1.0 was fully funded by The Robert Wood Johnson Foundation (RWJF).
• RAND 2.0 was funded by RWJF, the National Institute for Health Care Reform, The Health Foundation of Greater Indianapolis, and self-funded employers across the country.
• RAND 3.0 and RAND 4.0 combined funding from self-funded employers and foundations.
• PT5 (RAND 5.0) combines funding from self-funded employers and foundations.

No funding from hospitals or from health plans is accepted.

The Federal Trade Commission (FTC) and the U.S. Department of Justice (DOJ) share responsibility for monitoring mergers and anti-competitive behavior and protecting consumer interests through enforcement of antitrust law. In 1996, the FTC and DOJ  released guidance describing their general approach to antitrust enforcement in the health care industries, and the FTC and DOJ have issued more recent guidance relating specifically to Accountable Care Organizations and to the public disclosure of contracts between health plans and providers. Hospitals and health systems would put themselves in legal jeopardy with the FTC and DOJ if they engaged in private exchanges of information regarding prices and costs for anti-competitive purposes (“price fixing”).

The FTC and DOJ recognize, however, the potential benefits of public exchanges of health care price and cost information, and they have defined a “safety zone” for such exchanges. The FTC and DOJ make clear, “public, non-provider initiated surveys may not raise competitive concerns,” as long as they are “for procompetitive purposes.” The current study, given that it is initiated and supported by employers in their role as purchasers of health care, is clearly procompetitive in its intent, execution, and impact.

Data sources used in Sage Transparency will be queried once a quarter to obtain the most current information from each source if updates have been made. Sage Transparency 2.0 data updates last occurred August 22, 2024.

Yes. To purchase the data from Sage Transparency, simply click the “Purchase Data” button on the Sage Transparency landing page and follow the prompts.

Download a sample data extract (XLSX)

Sage Transparency 2.0 will use data from the Employer Price Transparency Study (PT5), conducted by RAND, to provide hospital, ambulatory surgery center (ASC), and medication price metrics. Hospital and ASC data represents the prices employers and insurance plans paid for health care as compared to what Medicare would charge for the same service. Medication data is represented as a ratio of the commercial prices paid for these medications versus the average sales price.

The NASHP Hospital Cost Tool provides Sage Transparency with key metrics: commercial break even price, operating profit margin per payer type, and payer mix. Commercial break even is the reimbursement rate a hospital needs to receive from commercial payers to cover all of its expenses for hospital inpatient and outpatient services, without profit.

The NASHP Hospital Cost Tool includes revenue from all sources, commercial patient hospital costs, as well as shortfall or profit from public coverage programs, Medicare disallowed costs, and other expenses, such as hospital operations, administration, ancillary services, and non-operating expenses.

View more about the NASHP Hospital Cost Tool (2011-2022 data) at:  https://tool.nashp.org/

Hospitals by Legislator: Sage Transparency 2.0 features licensed data that identifies state and federal legislators and the hospitals in their districts. This enhancement helps users reach out to the appropriate legislators about hospital issues and provides policymakers with key information on pricing and quality in their district.

View more about January Advisors at: https://www.januaryadvisors.com/.

Quantros quality data from Healthcare Bluebook is risk- and severity-adjusted to allow accurate comparisons, and integrated into a single, multi-dimensional composite score and rating. Employers, benefits companies, insurance brokers, and more use this data to optimize value-based success and identify high-quality facilities for patient referrals.

Learn more about Quantros at: https://www.healthcarebluebook.com/explore-quantros

Quality Star Rating: CMS uses a five-star quality rating system to measure Medicare beneficiaries’ experience with their health plans and the health care system. The overall hospital star rating summarizes a variety of measures across five areas of quality into a single star rating for each hospital. Once reporting thresholds are met, a hospital’s overall star rating is calculated using only those measures for which data are available. The average is about 37 measures. Hospitals report data to the Centers for Medicare & Medicaid Services (CMS) through the Hospital Inpatient Quality Reporting (IQR) Program, Hospital Outpatient Quality Reporting (OQR) Program, Hospital Readmission Reduction Program (HRRP), Hospital-Acquired Condition (HAC) Reduction Program, and Hospital Value-Based Purchasing (VBP) Program.

The latest methodology uses a simple average of measure scores to calculate measure group scores and Z-score standardization to standardize measure group scores for the following five measure groups.

1. Mortality
2. Safety of Care
3. Readmission
4. Patient Experience
5. Timely & Effective Care

Learn more about CMS Quality Star rating data at: https://data.cms.gov/provider-data/dataset/xubh-q36u.

Patient Experience Star Rating – Hospital ratings from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), a national, standardized survey of hospital patients about their experiences during a recent inpatient hospital stay.

Learn more about CMS Quality Star rating data at: https://data.cms.gov/provider-data/dataset/dgck-syfz.

Sage Transparency is free to use for all. The data contained in Sage Transparency will especially equip employers, purchasing groups, journalists, and elected officials with information which can help them better understand and compare prices.

To leave feedback about Sage Transparency, please use this form.

For questions about data, printing/exporting, or general use regarding Sage Transparency, contact us.

For media inquiries, contact Sara Otte at media@employersforumindiana.org or 812-390-8964.