Price transparency can help save money and resources across the healthcare system, while also improving American health and life, but only if the healthcare ecosystem takes the next step to make that data feasible.
Price transparency allows individuals to get the information they need to make informed health care decisions. President’s Executive Order (EO) of February 25Make the United States healthy again by empowering patients with clear, accurate and viable medical pricing information“emphasizes the opportunity for the healthcare industry to attract patients at every step of the healthcare journey, placing them in the driver’s seat when deciding what is the best choice for yourself or your family.
The president’s EO is not only another regulatory driver. This is a call for healthcare payers, providers and innovators to adopt transparency, collaboration and technology to meet the needs of modern healthcare systems and better enable patients to make smarter healthcare decisions. As an industry, we collectively have the tools to take transparency to the next level.
Catalysts of Change
In too many cases, today’s healthcare industry is hardly able to meet current transparency requirements and rarely can take actionable information to patients in his EO. As an industry, we can and must do more. In order to really take action, it is necessary to be accessible, understandable, and actively participate in this information.
Need transparency
Lack of transparency in healthcare has been a key barrier to patient trust for years. Unlike other industries, the opacity of healthcare prices can make patients feel uncertain and even focus on their affordable capabilities. Patients usually find only the cost of their care and how much of their responsibilities – when they often receive bills a few weeks after service.
This driving price transparency comes at a time when individuals increasingly demand greater control over healthcare decisions. We won’t stand the mystery of “how much does it cost?” in any other industry, why should health care be different?
Patients are accustomed to digital convenience and are able to navigate and control most of their lives from their phones. A recent McKinsey survey shows that patients are in demand and expect healthy tissue to adapt and meet patients and be ready to be available when needed. This is not more real about patients’ desire to be priced in health care within reach.
How do we really engage patients in their healthcare journey?
While regulations may drive health care organizations to disclose more pricing information (i.e., contract rate requirements for health care services available in machine-readable files), raw data is often provided in difficult-to-read formats, or frankly, incomprehensible. How many Americans really understand that routine colonoscopy requires a 34578 CPT code for gastroenterologists and individually charge for facilities that perform care and perform anesthesia bills individually (varies depending on the type and quantity of anesthesia)? The President’s EO stressed that data must be feasible to make it easier for patients to interpret and use.
To help drive patients to participate, they need reasons to take care of and act. Health program incentive programs that have become increasingly popular in recent years have proven that they can help drive changes in this behavior. In fact, many states have implemented or are considering implementing purchase rights to inspire patients to choose high-quality, low-cost care. When health plan members make informed health care choices, they may cut savings, which encourages patients to participate in choosing low-cost, high-quality care. Other incentives, such as gift cards for participating in annual health visits or prepaid cards for receiving flu shots, can prompt members to take action to take responsibility for their care and bring about improved results.
Embrace innovation through ecosystem partnerships
Pricing data is just part of the puzzle. These data are most feasible when enhanced through network coverage, out-of-pocket calculator, provider demographic data, and quality assessment and ratings. No organization has all the works or first-class in all fields. Effectively turning pricing data into patient action plans is necessary.
Imagine a person can quickly and easily search, evaluate and select high-quality providers or experts, understand the full range of what their insurance will cover, know exactly what their out-of-pocket expenses are, and schedule their appointments? With today’s technology, this is not only possible, but has happened in some cases. Now is the time for the rest of the industry to step up.
To be successful, patients need to use the tool to make a complete healthcare shopping, selection and planning experience considering the next step in their healthcare journey and when to do a complete healthcare shopping, selection and planning experience. This is where ecosystem partners provide data and other features that can help patients, providers and their health plans (from authorized admissions, activation and guidance patients to make good health care decisions). This includes from leveraging AI cost modeling and cloud-based systems that integrate data from multiple sources to provide more accurate estimates of healthcare program cost, to continuously monitoring and updating basic provider data such as contact information and working hours using partner-supported AI to ensure health plan members have access to accurate information when needed. It can then enhance the payer’s ability to provide members with health care services and highly personalized advice from the provider.
We can leverage existing technologies to achieve high-quality care and cost savings in current healthcare systems. However, this level of innovation and the ability to turn data into actionable insights cannot happen in isolation. No entity can solve the transparency puzzle alone. Payers can continue to work with partners, not only in line with the letter of new regulations, but also in line with the intentions behind the president’s recent EO, effectively achieving innovation Large-scale.
By working with partners who understand the regulatory and technical landscape, health programs can effectively integrate tools that meet EO tasks and the evolving needs of their members. This leads to a more efficient, cost-effective and member-friendly healthcare experience, paving the way for a future where members have greater control and understanding of their healthcare.
Keep patients involved
Patient-centric health care first allows us all (all of us) to buy quality and economical health care the same way as buying a car or groceries. By accessing more detailed pricing data, individuals can compare service costs and choose the provider that best meets their care and affordability needs.
The Health Program has the opportunity to guide its members through a center of excellence that emphasizes surgical care, primary care physicians and specialists based on clinical support to make high-quality and cost-effective decisions. Additionally, they can enable members to create, share and read reviews with the provider and facilities’ personal experiences so that other members can make smarter choices.
Members can also personalize the “shopping” experience, which will increase trust and engagement when members receive care advice that makes sense for their specific needs.
And we cannot underestimate the value of human touch. For those members who need additional support, the health plan can provide a set of tools and services to help, such as printing and sharing provider information offline, or a concierge team that can make an appointment via phone, email or chat or even make an appointment.
Prepare for the future
Stakeholders across the industry have an unparalleled opportunity to transform our healthcare industry and enhance patients’ capabilities with viable price transparency.
Healthcare payers must prepare members for their participation in the future as a healthcare experience center. Price transparency can make patients a seat in their healthcare experience in ways that have not been done yet – will you be part of the change?
Photo: Sinemaslow, Getty Images
Heather Cox has been at the forefront of architecture and leading disruptive fintech, HealthTech, data and digital businesses throughout his career, from the early days of E*Trade (originally one of Fintech Innovators’ industries) to most recently as Humana’s chief digital health and analysis officer. She is currently the President of Sapphire Digital at Zelis Healthcare, one of the leading platforms in the healthcare industry for provider selection, patient access, price transparency and digital consumer navigation.
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