New Old Idea: Price Transparency for Health Plan Members

The long awaited and much anticipated price transparency mandates for health plans have finally been released. A lot of opinions have been expressed as insurers, consumer advocates and the government worked through the process to finalize the rule. At HealthSparq, we’ve had many discussions with clients over the last year in anticipation of the final rules and to start planning on how to meet them.

With all the buzz happening following the announcement last week, the image that came to mind for me was “if a tree falls in the woods…” On one hand, I am excited and appreciate the focus on making health care pricing available and understandable. On the other, it’s frustrating. Some of the comments I’ve seen since the announcement imply that this work will be the first of its kind – that’s simply not true. Providing people with personalized cost estimates based on their benefits in real time is something we do every day.

Within the 556 page document released by the Trump administration, there is an acknowledgement that these tools do exist (as many as 94.4 percent of surveyed plans and issuers already maintain and operate an internet-based self-service tool) and a call to action for health plans that I could not agree with more. It states that they, “strongly encourage plans and issuers to develop educational and outreach materials to promote awareness that self-service tools exist, where to find them on the plan’s or issuer’s website, and how to use the tool.” In sum, it’s clear we need to do a better job of making sure people are aware that this information is available and that it’s trustworthy and easy to understand.

It’s important to add that in order to meet the new required mandate, there will be additional investment needed. However, we need to look beyond “checking a box” and begin to create innovative ways to promote these tools, engage people and allow them to make informed choices. We also need to continue improving the experience and meet people where they are. We have to provide clear information via personalized, curated results; help people understand their options and guide them to the right doctor, at the right location at the right time; present choices of virtual and traditional care based on what they are looking for and give them the ability to book an appointment in real time. We also need to integrate with doctors to ensure they have access to the same information, so it can be shared at the point of care and when making a referral.

The fact these mandates were necessary proves we still have a ways to go. My hope is they launch a new wave of passion within the health plan industry focused on helping people navigate a complex system. I look forward to being a part of the solution.