Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Claims Management News

4 Ways Payers Could Improve Healthcare Price Transparency

Patient portals and comparison shopping tools could help payers enhance healthcare price transparency.

By Vera Gruessner

Healthcare price transparency remains a key issue for health payers across the country. In order to strengthen member retention efforts especially during open enrollment periods, payers will need to boost price transparency to improve consumer satisfaction. One survey released by HealthEdge in October shows that as many as 88 percent of consumers are looking for better healthcare price transparency from their health plans.

Use patient engagement tools

Patient Engagement Tools

One way payers could improve cost transparency and meet consumer needs is by encouraging the use of patient engagement tools. Payers could make sure to partner specifically with providers that include patient portals in their practice. Portals and patient engagement tools will need to include cost estimators and offer user-friendly payment options in order to have an impact on healthcare price transparency.

One survey conducted by Porter Research and Navicure of about 300 executives and medical billing managers shows that 53 percent of respondents use online bill pay through their portals. Additionally, 33 percent of poll takers have cost estimation tools and 26 percent provide electronic billing statements. Payers may need to partner with these type of healthcare systems to make progress in their price transparency.

“Patient payment responsibility will continue to increase given the steady rise of healthcare costs and insurance premiums,” Jim Denny, founder and CEO of Navicure, said in a company press release. “This study proves that patient consumerism is further complicating healthcare economics for both patients and their providers, but there is good news: there are solutions that exist today that can make healthcare cost transparency and payments simpler.”

Implement retail strategies

Health insurance companies as well as hospitals could benefit from taking on strategies from the retail industry. PricewaterhouseCoopers Health Research Institute released a report in October that shows lower patient volumes due to increasing patient financial responsibility led hospitals to borrow some approaches from retailers in an effort to improve healthcare price transparency.

Price quotes, streamlined billing practices, money-back guarantees, and patient outreach are some of the retail strategies payers and providers have implemented for better cost transparency and member retention.

Innovate with vendors

According to recommendations from the Healthcare Financial Management Association (HFMA) Price Transparency Task Force, health insurers should work with their vendors to further innovate and create price transparency tools. Using varying frameworks to show costs to members could lead payers to determine the best strategy for their price transparency improvements.

Innovating with product vendors could help health plans create more effective communication channels with their members.

Comparison shopping tools for in-network, out-of-network providers

The HFMA Price Transparency Task Force also outlined the need to provide consumers with comparison shopping tools. Health plans will need to include pricing information for specific medical services when creating a cost estimate. Explanations of the type of services are also recommended.

If a patient compares costs for a radiology visit, for instance, he or she should be able to see price estimates of each facility for image costs and the radiologist’s fee for analyzing the image.

The difference in cost between in-network and out-of-network healthcare providers is also necessary when implementing comparison shopping tools for consumers. When it comes to out-of-network medical services, the provider will need to be the primary source for pricing information, the HFMA Transparency Task Force stated.

“A growing number of patients face significant financial responsibility for healthcare services and are becoming increasingly price sensitive,” the HFMA report stated. “As consumer price sensitivity has intensified, so too has media attention to healthcare prices. Providers that can speak accurately and confidently about their prices will be better positioned to succeed in this environment than providers that can only refer back to their charge schedule.”


Dig Deeper:

How to Overcome the Challenges of Bundled Payment Models

Key Steps for Payer Success in Accountable Care Organizations


Sign up for our free newsletter:

Our privacy policy

no, thanks