Healthcare Price Transparency is More Than Showing a Price Tag
Price transparency can help save money and resources across the entire healthcare system, while also improving the health and lives of Americans, but only if the healthcare ecosystem takes the next step to make that data actionable.
Price transparency empowers individuals with the information they need to make informed healthcare decisions. The president’s February 25th Executive Order(Opens in a new window) (EO) “Making America Healthy Again by Empowering Patients with Clear, Accurate and Actionable Healthcare Pricing Information,” underscores the opportunity for the healthcare industry to engage patients at every step of their healthcare journey, putting them in the driver’s seat when deciding what is the best choice for themselves or their families.
The president’s EO is not just another regulatory nudge; it is a clarion call for healthcare payers, providers, and innovators to embrace transparency, collaboration, and technology to meet the demands of a modern healthcare system and better equip patients to make more informed healthcare decisions. Together, we as an industry have the tools to take transparency to the next level.
A catalyst for change
In too many cases, the healthcare industry today barely meets current transparency requirements, and rarely makes that information actionable for patients, as the President calls for in his EO. As an industry, we can and must do more. To be truly actionable, prices must be easily accessible, understandable, and patients need to be actively engaged to act on that information.
The need for transparency
For years, the lack of transparency in healthcare has been a critical barrier to patient trust. Unlike other industries, the opaqueness of healthcare prices can make patients feel uncertain and even concerned about their ability to afford care. Patients often only discover how much their care costs—and how much of that is their responsibility—when they receive their bill often weeks after services are rendered.
This push for price transparency comes at a time when individuals are increasingly demanding greater control over their healthcare decisions. We wouldn’t put up with the “how much will it cost?” mystery in any other industry, why should healthcare be different?
Patients are used to digital conveniences and the ability to navigate and control much of their lives from their phones. A recent McKinsey survey(Opens in a new window) shows that patients increasingly demand—and expect—healthcare organizations to adapt and meet patients where they are, and to be readily available when they need assistance. This couldn’t be truer for patients’ desire to have easy and actionable healthcare pricing at their fingertips.
How do we truly engage patients on their healthcare journey?
While regulations will likely drive healthcare organizations to disclose more pricing information (i.e., requirements to make contracted rates for medical services available in machine-readable files), that raw data is often either provided in hard-to-read formats, or frankly, incomprehensible. How many Americans truly understand a routine colonoscopy entails a 34578 CPT code for the gastroenterologist, AND a separate charge for the facility where the care is performed, AND separate bills for anesthesia (costs that vary depending on the type and amount of anesthesia)? The president’s EO stresses that data must be actionable, making it easier for patients to interpret and use.
To help drive patients to engage, they need a reason to care and a reason to act. Health plan incentive programs, which have gained popularity in recent years, have proven they can help drive this behavior change. In fact, many states have already implemented or are considering implementing Right to Shop(Opens in a new window) programs which incentivize patients to choose high-quality, lower-cost care. When health plan members make smart healthcare choices, they could get a cut of the savings, which encourages patient engagement in selecting lower-cost, high quality care. Other incentives, like a gift card for attending an annual wellness visit or a prepaid card for receiving the flu shot can prompt a member to act, take charge of their care and lead to improved outcomes.
Embracing innovation with ecosystem partnerships
Pricing data is only one piece of the puzzle. This data is most actionable when augmented with network coverage, out-of-pocket calculators, provider demographic data, and quality reviews and ratings. No one organization has all the pieces or is best-in-class across all domain areas. Partnership is necessary to efficiently turn pricing data into a patient action plan.
Imagine a scenario where an individual can quickly and easily search for, evaluate and select a high-quality provider or specialist, understand the full scope of what their insurance will cover, know exactly what their out-of-pocket expenses will be, and schedule their appointment, all in one place? With today’s technology this is not only possible, but in some cases is already happening. It is time for the rest of the industry to step up.
To be successful, patients need access to tools that enable a complete healthcare shopping, selection, and scheduling experience where and when they are considering the next step in their healthcare journey. This is where data and other capabilities provided by an ecosystem partner can help patients, their providers, and their health plans—from empowering enrollment, to activating and guiding patients to make good healthcare decisions. This includes everything from leveraging AI cost modeling and cloud-based systems that integrate data from multiple sources to provide more accurate healthcare procedure cost estimates, to using partner-enabled AI to continuously monitor and update basic provider data like contact information and hours, ensuring health plan members have access to accurate information when they need it. It can then enhance payers’ abilities to provide highly personalized recommendations to members for healthcare services and providers.
We can leverage existing technology to achieve both high-quality care and cost savings within the current healthcare system. However, this level of innovation and the ability to transform data into actionable insights can’t happen in isolation. No single entity can solve the transparency puzzle alone. Payers can lean on and collaborate with partners to meet not just the letter of the new regulations, but the intent behind the President’s recent EO, efficiently enabling innovation at scale.
By working with a partner who understands the regulatory and technological landscape, health plans can efficiently integrate tools that meet both the EO’s mandate, and the evolving needs of their members. This results in a more efficient, cost-effective, and member-friendly healthcare experience, paving the way for a future where members have greater control and understanding over their healthcare.
Keeping patients engaged
Patient-centered healthcare starts by allowing patients — all of us — to shop for quality and economical healthcare the same way we shop for cars or groceries. By having access to more detailed pricing data upfront, individuals can compare the cost of services and choose providers that best meet their needs both in terms of care and affordability.
Health plans have an opportunity to guide their members to make both high-quality and cost-effective decisions by highlighting centers of excellence for surgical care, primary care physicians and specialists based on clinically-backed quality measurements. Additionally, they can empower members to create, share, and read reviews on personal experiences with providers and facilities so other members can make more informed choices.
The ‘shopping’ experience can also be personalized for members, which will increase both trust and engagement when members receive care recommendations meaningful to their own specific needs.
And we can’t underestimate the value of human touch. For those members who require additional support, health plans can offer a set of tools and services to help, such as printing and sharing provider information offline or a concierge team who can advise via phone, email or chat, and even book or switch appointments.
Preparing for the future
Stakeholders across the industry have an unparalleled opportunity to transform our healthcare industry, empowering patients through actionable price transparency.
Healthcare payers must prepare for a future where member engagement is at the center of the healthcare experience. Price transparency could put the patient in the driver’s seat of their healthcare experience in a way that hasn’t yet been done before — will you be part of the change?
Photo: sinemaslow, Getty Images
Heather Cox(Opens in a new window) has been at the forefront of building and leading disruptive fintech, healthtech, data and digital businesses throughout her career, from the early days of E*TRADE (one of the industries first fintech innovators) to most recently serving as the Chief Digital Health and Analytics Officer for Humana. She is currently President of Sapphire Digital at Zelis Healthcare(Opens in a new window), leading one of the healthcare industry’s leading platforms for provider selection, patient access, price transparency, and digital consumer navigation.
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