The healthcare ecosystem is rolling slowly toward greater pricing transparency, but there are many challenges. Among them is predicting consumer behavior in the fog of new health information that is becoming available to them. The latest catch-phrase for consumer empowerment could very well be “500 shoppable services.”
Shoppable services are healthcare services in which consumers can select treatments as single units of care, without the pressure of an emergency situation or receiving care in a “captive” setting where they can’t choose their provider. Think mammograms, imaging and laboratory services.
Three government agencies – the Departments of Health and Human Services, Labor and Treasury – collaborated on the Transparency in Coverage Act, which was released in Final Rule form in late 2020. This set in motion a series of major initiatives that are moving pricing out into the open over a period of years.
Hospitals are already required to post some prices on the internet, but many have not done so. Often, those that have complied have obscured the data in ways that make it difficult to locate and understand.
Payers will be required to publish prices for covered services in a consumer-usable online format for 500 shoppable services by Jan. 1, 2023. The remainder of covered services pricing must be published by Jan. 1, 2024. HealthEdge is working with its health plan customers to support compliance.
The question is, what does it take for consumers to actually shop for lower-cost services? Look to a Kellogg School of Management study that shows consumers will indeed make logical economic choices when price information is presented in simple, apples-to-apples formats. The study revealed that even for serious care, people are often willing to sacrifice hospital prestige or drive to a more distant location to save on cost.
The Kellogg report notes that providers will view the disclosure of prices differently according to their place in the pricing structure. Those in the mid-range stand to lose the most from price transparency, the study author notes. Lower-priced providers will naturally gain more patients; premium providers are often seen as worth the additional cost.
HealthRules Payor provides a robust engine to calculate cost-sharing information that is unique to the member and the provider’s status in real time. The platform can deliver these results via the health plan’s member portal, which allows members to consider price information at the same time they review provider directory data like languages spoken and customer satisfaction ratings. Cost calculations flow from the claims adjudication system; therefore, the risk of results being skewed by stale data is reduced to zero.