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Ever Get a Medical Insurance Bill That Seemed More Expensive Than It Should?

Patients now have more options, because of a Whitehouse initiative on healthcare price transparency, to shop for care not just based on price but on a range of other qualities.

stethoscope and bill HLS CIO

It’s looking like 2020 was only the first act for head-turning changes in healthcare. Now, payers are under pressure to provide price transparency on the most common covered items and services. And all by 2022. Will you be ready?

Forty-one percent of healthcare organizations typically take up to a year to integrate new regulations, policies, and other changes, according to a Salesforce HBR Analytics Services Report. And the challenge isn’t just about setting up a catalog with prices. Price transparency is likely to change the way payers, providers, and patients connect with one another at every touchpoint — from enrollment to shopping to overall engagement.

The goal behind the White House initiative, named Improving Price and Quality Transparency in American Healthcare to Put Patients First, is to give patients the payment information they need before they agree to a service. No more sticker shock.

Already, hospitals are on the hook to provide prices, based on who is paying, for 300 “shoppable” services — like elective surgery for a hip replacement. The list may seem short but these elective items account for 43% of out-of-pocket spending, according to the Health Care Institute.

To get ready for this next round of innovation and change, take a hard look at these three areas: your business models, reimbursement, and customer engagement.

Bring your systems together

Ready for a sad truth? The fax machine is still very much a part of the operations side of healthcare. That doesn’t bode well for payers when consumers should be able to shop for procedures and compare offerings the way they can on Google Shopping.

Payers need a single digital system of engagement that can integrate different pieces of data to create a singular customer experience. This system should include flexible application programming interfaces (APIs) that limit coding and can speed up this go-live process.

OneShare Health, a sharing ministry that provides services similar to a traditional insurer, is on the path to saying goodbye to paper with Salesforce. “Being able to bring together all our different fee schedules and different pricing structures was a really exciting thing,” said Kim Waters, executive vice president of Provider Networks. No more spreadsheets or routing bids to get repriced in another system.

“To have all those things in one place really empowers our team to be successful and give good information,” Waters said.

The visibility also changes the way you create new products and bring them to market. You can use pre-built processes and workflows for partnership management and other routine activities.

Innovate reimbursement models

Even before the executive order, healthcare was moving toward new models for reimbursement. The pandemic has accelerated this trend. Value-based models and risk sharing are likely to play an even bigger role going forward and now is the time to think about other ways to incentivize efficient, quality medical care. Patients will have more options and shop for care not just based on price but on a range of other qualities.

This means education for both physicians and members must be a central pillar, with digital portals that offer personalized guidance according to their needs. Of course, healthcare pricing and education are not as simple to assemble as a college catalog. You will need to create a scalable plan design integrated with provider networks and eligibility rules to successfully support transparent pricing into user experiences.

Anticipate patient needs and deepen engagement

OneShare uses its platform to anticipate its customers’ needs. “We are trying to identify when they may be on a path toward a need in care,” said Waters. This is a critical point: with a combination of analytics and artificial intelligence from a single platform, you can anticipate needs and set up marketing journeys to help your members understand their own needs and prepare for them. Then you can send reminders to members and show them you’ve got their back.

With the right system, you can enable consumers to check off key requirements when they are planning a medical service: geography, cost, and quality. Structured journeys help members tackle problems before they become big issues and gently escort them step by step through the care-selection process.

Tools like Tableau CRM provide intelligent insights into data and automate next best actions, from enrollment through shopping and pricing. Artificial intelligence (AI) infers what they have a propensity to do and suggests a course of action – in plain English.

Deepen trust and collaboration

People like to say that healthcare is something everyone needs but it can still be difficult to understand. The new rules will help to change that and invite all participants to engage more fully.

Price transparency is long overdue and will have a ripple effect throughout the healthcare system, empowering the consumer to make informed decisions so they can get the best quality care at lower prices. Payers need to be ready.

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