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Many healthcare organizations’ cost transparency tools fall short on goals and member usage because they fail to incorporate these critical elements.
Given the significant cost variances across healthcare providers for the same procedures and services, cost transparency tools are one way that health plans can educate their members about available options and encourage them to be active consumers of their healthcare, says Tom Meier, vice president of market solutions, Health Care Service Corp.
MobleyAlthough many plans now offer cost transparency tools, Erica Mobley, director, communications and development, The Leapfrog Group, says most have significant shortcomings. For example, some fail to share sufficient information on the safety and quality a patient can expect to receive for that price. “Patients need tools to help them find the highest value care, i.e., the right care at the right price. Unsafe, low-quality care has no value, regardless of the price.”
Another problem is that reportedly, many of these tools have actually resulted in higher spending, not lower expenditures as tool developers and others had anticipated. This was reported in a 2016 study in JAMA “One reason behind this is that people tend to associate higher cost with higher quality, which further reinforces the importance of incorporating quality data into any cost transparency tool in order to ensure [these tools] don’t have an adverse effect on spending,” Mobley says.
Ashraf Shehata, MBA, MHA, advisory leader for health plans and member of KPMG’s Global Healthcare Center of Excellence, KPMG LLP, also maintains that there’s a lot of room for improvement. “Many comparison shopping tools online only cover the most common procedures and a lot of providers are not eager to publish pricing information online,” he says.
Consumers are looking to transparency tools to help them determine where to receive treatment, how to lower out-of-pocket expenses, and how to evaluate the quality of the services they will receive. More consumers are becoming mobile, often researching physicians and care options while on-the-go in real time.
Here are three attributes of successful transparency tools:
1. Ease of use. “Health plans need to develop easy-to-use digital transparency tools that help cut through confusion, highlighting differences in cost and quality between providers,” Meier says. “In addition to digital solutions when choosing a provider and making an important healthcare decision, consumers often want to have a conversation with someone. By providing digital and telephonic transparency solutions, we can empower members to make informed decisions and engage with them in the channel of their preference.”
Mobley says consumers are used to accessing easily digestible and readily available information through their smartphones and tablets; a cost transparency tool shouldn’t function any differently than other apps such as Yelp or TripAdvisor that they would use to research a service or amenity outside of healthcare.
2. Tailored to the individual. Members want to ensure that the information they view is personal. “They want tools that accurately predict the overall cost of tests, procedures, and treatments while calculating their unique out-of-pocket expenses,” Meier says. “They also want information and costs that apply to their specific health benefit plan so they can estimate their cost of care regardless of where they are in the benefit year.”
3. Trustworthiness and reliability. Shehata believes patients desire to be confident that they will be covered and won’t have any unexpected fees sprung on them after a healthcare encounter. “This has become even more important as more people are getting coverage through high-deductible plans,” he says. “If someone is responsible for the first $2,500 to $5,000 of out-of-pocket healthcare costs, comparison shopping is important and necessary. Although there isn’t much time to bargain in an emergency, there is time to compare costs for elective procedures. Prices for procedures can vary widely, so this type of transparency levels the playing field for patients.”
To get more members to use these tools, plans need to include more information in them, both in terms of expanding the conditions listed and also the price range data from individual providers.
“It will require cooperation from providers; the ability to reveal prices to members may need to be written in some contracts with providers,” Shehata says. “Plan design and the increased cost shifting to members is going to make these tools a necessity, so links may need to be more prominently featured online and not only on regular web browsers but also optimized for mobile phones and tablets. Health plans should encourage members with chronic illnesses to use these tools because they are the ones generating most of the costs. Health plans will need to use simple language to help engage members to determine the cost of procedures, describe what their benefits will cover, and find out which providers offer the best treatment.”
Mobley believes health plans should promote tools through digital advertising forums which will allow consumers to see them in places where they are already going for news and information, including social media platforms such as Twitter and Facebook. “Plans should also consider offering a financial incentive to members who use a transparency tool to choose a provider and then schedule and attend an appointment with that provider,” she says. “This incentive could be as simple as a $5 Starbucks gift card.”
Plans can increase customers’ use of these tools by expanding them from digital-only to multi-modal channels such as mobile, text, and audio/visual, and as a result, increase the potential savings, Meier says. Additionally, transparency tools combined with benefit designs such as reference-based pricing (i.e., paying up to a fixed amount for certain non-emergency services you can shop for) or incentives such as member rewards (i.e., a cash reward for visiting a lower-cost location) can motivate members to act on the information provided by the transparency solutions and ultimately select higher-value providers.
As members continue to see increased out-of-pocket costs and programs that offer financial incentives for selecting quality and lower-cost providers, Meier expects to see increased use of transparency tools across multiple channels (i.e., digital, mobile, text, and telephonic). In addition, he expects underlying transparency information to be embedded into other aspects of healthcare, such as benefit designs, incentives, and networks.
Finally, the future of cost transparency tools will undoubtedly be impacted by the shift from fee-for-service reimbursement to value-based care arrangements. “As financing arrangements shift more risk to providers, we expect providers to increase the use of transparency information given new financial incentives,” Meier says.
Consumerism continues to increase in healthcare, and consumers are thirsty for cost and quality transparency tools that will help them navigate these waters, Mobley concludes. Tools that successfully enable patients to find the highest value care-the right care at the right price-will see their usage grow.
Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.