4 MIN. READ

Improving price transparency in healthcare settings

With the rise of consumerism in the healthcare industry, more and more patients and their caregivers are becoming more educated, active participants in their care. As individuals become more knowledgeable, savvy consumers of medical services, they are increasingly taking charge of their health plans and demanding better access to information to make more-informed decisions.

The absence of price transparency, however, continues to hinder patients’ ability to make value-based decisions about their care.

Industry experts opine that the lack of transparency in healthcare costs and pricing can be attributed to a financial system with complex arrangements among patients, providers, third-party payers and employers. Such arrangements make it difficult to provide patients with accurate costs of specific medical procedures and services.

Increased demand for price transparency

Healthcare consumers have been asking for price transparency for some time now, especially since the advent of consumerism and the rise of high-deductible health plans. Although many providers attempt to meet consumer expectations by providing prices of medical procedures and services on their websites, there remain many variables that affect the cost, and ultimately the bill a patient receives.

Factors such as the location of the health institution, the nature of a patient’s health plan coverage and negotiated discounts affect the cost of care and can change the amount of financial responsibility the patient has to bear.

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How providers can deliver transparency

The lack of transparency increases patient confusion and makes it difficult for them to arrive at value-based decisions. As healthcare consumers increasingly take charge of their care decisions, providers should work to communicate costs or risk losing their customer base and the revenue along with it.

A report survey found that 69% of healthcare consumers want insurance companies to disclose what they pay hospitals and physicians for procedures, while 82% of people who have compared healthcare prices admitted they would do so again.

Following through on price transparency initiatives helps assuage patient fears while raising satisfaction levels and increasing loyalty. That’s because consumers see such providers as trusted advocates and partners that help them navigate the financial confusion inherent in the industry.

Because of differing insurance packages and payment plans, achieving transparency goes far beyond publishing a price list on a website. But, how can providers do more to meet consumer requests to deliver price transparency?

Developing easy-to-use resources that help simplify the complexities of care pricing is one of the best ways to address those challenges in healthcare settings. User-friendly applications on mobile devices can engage patients to help them better understand the cost of services they receive or anticipate receiving, enabling them to make more-informed decisions and quickly get the care they need.

Innovative apps and platforms

Many telehealth and healthcare companies, insurance firms and even providers are creating and pioneering the use of innovative and helpful tools that enable price transparency in healthcare settings.

In the payer space, Blue Cross Blue Shield of North Carolina provides patients with a public Web-based Cost Estimator that provides cost estimates for provider procedures. It uses claims data collected over a 12-month period to calculate the average cost of a procedure, inclusive of medical supplies, drugs, anesthesia, facility fees and physician services.

Trusty.care enables patients “who don’t have a degree in Medicare” to understand the deep world of government-funded healthcare. The platform is a diagnostic tool that enables users to maximize all the government-funded financial benefits while considering their individual health needs.

Other examples include the Change Healthcare mobile and tablet app, which provides better access to the quality and cost information healthcare consumers need to make value-based healthcare purchasing decisions. In addition, Waystar (formerly Navicure) has a predictive-analysis solution that provides full cost transparency by estimating patient financial responsibility, making it easier for providers to collect patient payments and patients to understand care costs.

Geisinger Health System also has developed a tool that provides patients with estimates of specific out-of-pocket costs for various ambulatory diagnostic services, while QwikScript is the first digital marketplace designed for patients seeking prescription medications with full price transparency.

Providers and physicians can use those resources to enhance communication and relationships with their patients. It’s essential, however, that they consider the patient’s insurance status (out-of-network insured, in-network insured or self-pay) whenever possible.

The way forward

Providing quality and pricing information can help patients choose low-cost, high-quality service providers and medical procedures that meet their needs and budgets. Using innovative tech solutions can help providers and organizations provide more-specific pricing information for consumers, thus improving the patient experience and ensuring better transparency.

Want to learn more about improving patient access to value-based care and healthcare costs with a user-friendly app or technology? Read Change Healthcare’s customer success story. Or to learn more about strategy, design, development or management services for your solutions, contact us.