Introduction to Blog Series:
Transparency in healthcare pricing has finally arrived with the passage of January 1st, 2024. The series of actions that have led us to this point goes as far back as the implementation of the Affordable Care Act, but more recently include the implementation and enforcement of the Hospital Transparency Rule, the No Surprises Act as part of the Consolidated Appropriations Act of 2021, and most notably (although not widely covered) the Transparency in Coverage Rule.
We’ve seen enforcement and resultant fines upon healthcare providers due to non-compliance with the Hospital Transparency Rule. Given the bipartisan and bicameral support healthcare transparency receives, active enforcement of the Transparency in Coverage Rule requirements will be seen throughout 2024 into 2025, where non-compliant actors will face business crippling penalties, loss of trust and credibility, and reduced revenue. The age of opaque healthcare pricing is nearing its end as the exorbitant healthcare costs borne by consumers have served as an important impetus for systemic change in the U.S. healthcare system.
With transparent healthcare pricing now available, what opportunities will come to light as a result of this massive data? For the first time in the American Healthcare System, symmetrical pricing information between and amongst stakeholders is publicly available. Therefore, the question must be asked – Who will recognize this opportunity and leverage it to their benefit and advantage?
In this blog series, TALON will help readers understand the new reality of transparent healthcare pricing, highlight its impact on the American Healthcare System, and outline how this data should be used for the benefit of all.
Healthcare Pricing and Cartography: Your GPS is now ready for use
Cartography is the fascinating field that encompasses both the art and science of making maps. It involves a blend of:
- Geospatial data acquisition, curation, and analysis
- Map projections and coordinate systems, and
- Visual communication
From the simple clay tablets of Mesopotamia to the sophisticated digital maps of the 21st century, cartography has provided humanity with a powerful tool for navigating the world and making the unknown knowable. Those with an inaccurate map, or without a map entirely, often wander aimlessly to their demise.
Prior to 2024, consumer navigation and steerage within the complex landscape of the American Healthcare System had mirrored the days of the sextant and the study of the stars. As much as the consumer may get to where they need to be, they inevitably face significant confusion, struggle, and frustration, and in some cases, their financial downfall. A recent study found that 56% of insured Americans have medical debt, compared to 59% of the uninsured population. Collectively, American medical debt totaled almost $200 billion1.
With the passage of the first of the year, the cartographers of healthcare pricing now have the data and tools to leap forward to the advent of a healthcare pricing GPS. Transparency in healthcare pricing is now a curated and personalized experience, like Apple Maps’ “Look Around” feature, and must be leveraged to contain costs and help consumers reach their intended destination safely and efficiently.
Healthcare consumers must be equipped with this navigation tool so that they can plan their healthcare journey and avoid surprise billing, establish and receive necessary care from high-value providers, gain control of their financial and physical well-being, and reward payers and providers who place them in the center of their mission.
The necessities for a truly impactful healthcare pricing navigation tool include;
- Mobile-first, adaptive application design
- Carrier/Payer provider directory accuracy
- Upstream negotiated pricing data integration
- Total Encounter cost capturing rates of all likely procedures to be performed
- Plan Design/Definition integration and hyper-personalization
- Integrated, dynamic savings rewards system
With this solution in hand (literally, it needs to be accessible via smartphone), the healthcare consumer can confidently navigate throughout their journey, buoyed by the availability of transparent pricing, quality metrics, and provider directory guidance. Our destination will have been reached when;
- consumers are empowered to evaluate healthcare options and make cost-conscious decisions;
- surprises are reduced in relation to individual consumers’ out-of-pocket costs for health care services;
- a competitive dynamic narrows price dispersion for the same items and services in the same healthcare markets;
- downward pressure on prices lowers overall health care costs; and
- high-value payers and providers are recognized both fiscally and reputationally by their delivery of consumer-centric principles
So how will you plan to reach this destination? Will you leverage the robust, innovative solution available, embrace and empower the consumer, and fundamentally transform the consumer experience within healthcare? Or will you continue to rely on the outdated, inaccurate maps of years prior, hopelessly drifting while unsustainable costs crash down?
In the next blog post within the TALON price transparency series, we will highlight why incorporating healthcare price transparency data will provide competitive insights and symmetrical information in the market for all key stakeholders.