Are Payers Moving Fast Enough Toward Transparency?
Health care is inherently personal, and what’s right for one consumer may be a no-go for another. The decision-making process is just as personal, with considerations ranging from recovery time to cultural preferences to the doctor or hospital, but it’s often hindered by the lack of one critical piece of information: what will my health care service cost?
The Centers for Medicare & Medicaid Services (CMS) is pushing new cost transparency mandates designed to fix that. Amid widespread consumer and employer demand for solutions that will help lower health care costs, the agency has proposed a set of rules that mirror for health plans its recent regulation to increase hospital price transparency.
While many plans already offer cost transparency, this new rule changes the requirements and health plans will need to move quickly once the rule is finalized, likely by the end of this year, to comply. With industry pushback on some components of the proposed rule, however, many health plans are taking a wait-and-see approach. We suggest doing the opposite—health plans should be preparing now rather than waiting for the final rule to be announced.
Here’s why: Compliance will likely end up being a heavy lift—after all, plans will need technology and processes to support the requirements. More importantly, though, consumers want and need transparency, with 78% reporting in a recent HealthSparq survey that they would like accurate information on how much they will pay out of pocket for services.
The mandate sets the framework for transparency—what a particular provider charges for a specific billable service—but people need context and guidance in order to compare options and make informed decisions. Health plans should be acting now to turn the conversation from mere compliance to how they can better serve their members.