An extraordinary transformation in commercial health insurance will begin on January 1 when the federal regulations known as the No Surprises Act and the Transparency in Coverage Rule usher in a new market-driven healthcare system. Many in the health insurance ecosystem view the requirements as hopelessly complex and onerous. Not us.
TALON views these mandates as a revolutionary catalyst to reduce healthcare costs through educating, empowering, and incentivizing the American healthcare consumer. The TALON platform, which served as the prototype for the legislation, can enable rapid compliance while engaging with healthcare consumers in exciting new ways in accordance with these mandates. The new market-driven healthcare environment also offers enormous opportunity and benefit for any stakeholder prepared to adapt to this new paradigm.
Winners in The New Healthcare Marketplace
Most stakeholders can win in the new market-driven healthcare environment. By law, members must be provided with an internet-based tool such as TALON’s MyMedicalShopper™ that presents personalized out-of-pocket cost estimates on medical services and items, from multiple providers, in advance. There can be no balance billing, and no surprise billings. Advanced Explanations of Benefits (EOBs) are now required. Likewise, Employers, especially those who offer high-deductible health plans, HSAs, and HRAs can experience significant reductions in their overall annual healthcare spend through incentivizing and rewarding smart healthcare consumerism.
Advisers can delight their employer clients by presenting high-value healthcare options that take advantage of these new regulations, and win new clients from competitors who are fearful of change; baffled by the new market-driven healthcare system, and saddled with legacy solutions and technology.
Third-party administrators, ASOs, and those who administer consumer-directed health accounts can provide clients turn-key compliance through a platform such as TALON, utilizing its data warehousing, machine learning, and smart consumerism tools to reduce inefficient healthcare spending and strengthen customer loyalty.
Many Payers large and small also stand to gain in the new healthcare marketplace utilizing a platform such as TALON’s. Archaic practices that incentivize waste and have propped up today’s fractured market are incompatible with the new market-driven healthcare system. The winners will take advantage by ridding networks of facilities and providers that cannot compete in a fully transparent, consumer-centric healthcare system.
Moving from the fractured market of today to the new market-driven healthcare system will create billions of dollars of savings to improve the balance sheets of American companies and the bank accounts of their employees. Employers should be aware of their vendors’ (e.g., advisor, TPA, insurer) readiness and plans to take advantage of the new healthcare marketplace. Though enforcement has been pushed out on some of the 1/1/2022 statutory dates, there are others which have not (e.g., such as QPA process, disclosures, provider directories). Employer risk of non-compliance is substantial: up to $100 per day per covered life, or over $84,000 per enrolled person per year. Employers must be prepared to prove that best efforts have been made to achieve compliance. Fines can be applied retroactively back to 1/1/2022.
Who Stands to Lose?
Who stands to lose in this new healthcare marketplace? The answer is clear: (1) providers whose charges cannot compete in an open, transparent, efficient market; and (2) stakeholders in the commercial health insurance ecosystem who fear change and lack the modern technology platforms to compete.
In development since 2014, TALON offers a turn-key solution for rapid compliance/safe harbor with the No Surprises Act and Transparency in Coverage Rule. Healthcare price transparency and smart healthcare consumerism for American businesses and their employees has for many years been our passion and our dream. Our team is ready to assist yours, going beyond compliance and safe harbor to position your organization to gain the full benefits that America’s new market-driven healthcare system offers.