Transparency: A Must-Have for Health Care Payments

Consumers need data to make their decision on which provider to choose. Yes, part of that includes price transparency, but high price doesn't always mean high quality. Human interaction is also crucial to a good doctor-patient relationship. Having a tool that displays in-network providers who are accepting patients, affordably priced and providing high quality is huge for empowering consumers in their health care journey.

2. COVID-19 has forced the rapid adoption of technology.

Even when we're through the pandemic and can begin to spend more time together face-to-face, there will be no going back to the old ways. Consumers expect digital solutions to carry out basic tasks. Not only do they expect to interact with businesses digitally, but they also expect to be able to access the information they need in an easy, intuitive way.

Health care has been less-than-stellar about digitizing. Making more services available through channels people are used to using for other consumer channels will not only improve the user experience but will also demonstrate a commitment to greater transparency from your business.

For example, self-service portals for both agents and clients would make it easier for them to manage their insurance needs. Mobile apps for client services and claims could help them easily understand where they are in the payment process. Quick, responsive customer support available through multiple channels, including email and chatbots, will help consumers feel empowered about their health care choices. Healthcare is confusing enough already; helping your clients where you will make a big difference.

3. Transparency is becoming law.

Government agencies are making transparency less optional in health care by enacting new laws. Lawmakers made sure to include transparency in the Coronavirus Aid, Relief, and Economic Security (CARES) Act by requiring providers of diagnostic tests to make the cash price of a COVID-19 test publicly available on their website.

COVID-19 isn't the only reason regulators are looking at transparency. Agencies have been enacting other laws designed to ensure that consumers know how much their health care costs before treatment, allowing them to make better-informed decisions.

As recently as October, the Centers for Medicare and Medicaid Services (CMS) issued a final rule on healthcare price transparency. Over the next few years, health plan providers will be required to:

• Make available files with detailed pricing information related to negotiated rates for all covered items and in-network providers, historical payments to/billing from out-of-network providers, and in-network rates and historical net prices for covered prescription drugs (effective Jan. 1, 2022)
• Make available through their website personalized out-of-pocket cost information for plan beneficiaries for 500 shoppable items and services (effective Jan. 1, 2023)
• Complete the pricing information for the remaining procedures, drugs, durable medical equipment and any other item or service (effective Jan. 1, 2024)

CMS is also finalizing a requirement to make this information available through an Internet-based self-service tool, which will empower consumers to shop and compare costs between specific providers before receiving care. Insurance plans and issuers will also have to disclose on a public website their in-network negotiated rates, billed charges and allowed amounts paid for out-of-network providers, and the negotiated rate and historical net price for prescription drugs.

Transparency is no longer optional.

Instead of waiting for government regulation and consumer advocacy movements to force greater transparency in the health care industry, the time to act is now. Offering your clients increased transparency into pricing will not only help your business but will create a better ecosystem for us all.

— Connect with ThinkAdvisor Life/Health on Facebook, LinkedIn and Twitter.

Terry Rowinski is president and chief executive officer of Health Payment Systems Inc.