It’s Finally Here.
The moment we’ve all prepared for—or have we? The simple fact is that when the second phase of the Transparency in Coverage Rule was rolled out on January 1, 2023, requiring plans to provide members with an online pricing tool containing easily accessible cost-sharing information for a list of 500 services, software companies providing this tool should have been ready for the final phase then. When you consider how technology development and data feeds work, is it really easier to take all available data sets for in network and out of network pricing, allowed amounts, accumulators, historical pricing information, and more, and separate out only the 500 initial required items and services? It’s almost like splitting hairs when you think of piecing together a solution in that way.
If data accuracy and getting answers to questions on timelines and preparedness for the January 1, 2024, requirement has been an uphill battle, the time to act is now. The importance of a well-developed software analytics system with the capability to accurately process and interpret large Machine Readable Files (MRFs) cannot be overstated. As an industry pioneer with a platform that has been around for nearly a decade, TALON’s suite of technologically advanced software provides accurate information that goes directly to the consumer so that they can make responsible healthcare purchase decisions. Our past influences how we look ahead to the future, which means that we proactively invest in creating solutions that can easily pivot when new healthcare changes emerge.
The Tool Alone Isn’t Enough.
If you’ve ever been caught in the middle of a poorly implemented health plan member solution you know that the tool is only as good as the member engagement. While some cost estimator tools may go so far as to prevent exposure to costly non-compliance penalties, that’s only the defensive strategy. What does your compliance solution offer that incentivizes and promotes member engagement and leads to true plan savings?
We understand that to create a complete transparency ecosystem that promotes engagement and collaboration, there are additional elements that need to be added to the mix. Our MyMedicalShopper™ tool is the first step and provides a simple way for members to access convenient and quality care. This is where most compliance service providers begin and end, but TALON was just getting started. MyMedicalRewards™ is our one-of-a-kind incentive program that rewards members for selecting low-cost, high-quality care options. Since the rewards are in the form of HSA, HRA, and/or debit account contributions, it’s a reinvestment into their care! This year we took our digital experience to the next level by adding an easy way for members to immediately use their rewards through TALONPay™.
It’s Not Slowing Down. Neither Are We.
With the movement we’ve recently seen on the PBM front, it seems the only way that healthcare reform is moving is forward. This could potentially create a compounding problem for compliance software solutions who are struggling to keep pace already. Lawmakers are continuously introducing and passing new legislation which builds upon the foundation of TiC and the No Surprises Act (NSA). The House of Representative recently passed the Lower Costs, More Transparency Act which, if passed by the Senate, would place even more requirements on hospitals for pricing disclosure and it would also improve transparency surrounding PBMs.1
Our vision for the US healthcare system is to help transform it into a truly market-driven industry with consumers at the center. This belief lights our way forward, so you can rest assured that we’ve been standing prepared for the regulations of today and the future.
