Transparency Mandates Alone Are Not the Answer
New federal price transparency mandates are well intentioned but focus primarily on the technical aspects of showing prices for covered medical services and prescription drugs. While increasing price transparency through this strategy will certainly have positive impacts for consumers, it doesn’t do enough to take the confusion out of health care.
People need data, certainly, but what they really need is relevant information and guidance that helps them decide on where and when to get care. Understanding that they can choose lower-cost services is important, but they also need the full picture of quality, provider attributes, and ease of access to care. The bottom line is that health plans will be missing the mark if they seek only to meet the letter of the mandate. This is an opportunity to build consumer trust by providing meaningful guidance to people in their health care journey.
People need help, not data
People often get treatments and that can include multiple procedures, visits and medications, and costs may include both professional and facility fees. Searching for individual billing codes people don’t understand isn’t useful. How do they choose? What else might they need? Guidance on what is relevant to their unique situation isn’t in the mandate, but critical to reduce the burden on consumers. Are they dealing with a chronic health condition, a one-and-done health situation like a broken foot, or need preventative or diagnostic testing? They need guidance on their options.
Provide the big picture for care planning
Today, many people can already get cost information based on billing codes or encounters—similar to the proposed mandate. For something like a surgery, even encounter-level surgery cost bundles don’t address what someone will have to pay for procedures, medications and equipment during evaluation or recovery. Plus, there is the time factor. How many visits would the treatment require? How long will recovery take? Someone may need outside help during recovery and take care of their daily needs or their family. The time involved has financial implications for people in planning for the cost of care.
Go beyond transparency and transform the experience
To really help people we need to take the complexity, and pain, out of health care navigation. Our industry can go beyond delivering of the foundation established by the final hospital and health insurance price transparency rules. We can provide useful insights in context to someone’s overall health needs and guidance on their options. We can ensure the information is delivered thoughtfully to help people make better choices, and not overwhelm them with numbers and industry benefit jargon. This is how price transparency can be truly effective at helping people navigate health care and lowering rising health care spending.
Let’s help people understand the big picture. Price transparency needs to deliver context for the health situation, actionable insights and guidance to help people make smarter choices. We’ve been focused on how to give people the right information at the right time so that they feel more in control of their health care experience for years, and are excited to work to take price transparency beyond data and relieve the burden of care planning for hundreds of millions of people.