Price Transparency

Key Regulations and Policies That Will Impact Payers in 2024

December 26, 2023 - As healthcare stakeholders and the federal government work to make healthcare more accessible and affordable for consumers, CMS and HHS are frequently introducing and finalizing new rules and regulations. There were a couple of key policies finalized in 2023 that will impact payers and their operations, some of which will take effect in 2024. Below, HealthPayerIntelligence explores the...

Read More


More Articles

Study Finds Geographic Variation in Payer Prices for Office Visits

by Victoria Bailey

Among a single health insurer, prices for office visits varied by geographic location, with the upper-Midwest and Southeast regions seeing higher costs, a study published in JAMA Health Forum...

UHC Commercial Plan Focuses on Price Transparency, Preventive Care

by Kelsey Waddill

UnitedHealthcare’s Affordable Care Act-compliant employer-sponsored health plan, Surest, is the payer’s fastest-growing commercial plan. Data indicates that Surest’s emphasis on price...

Unpacking What Price Transparency Looks Like for Health Plans

by Victoria Bailey

Consumers are struggling to understand and afford healthcare in the United States. A new federal requirement aimed at increasing healthcare price transparency aims to help, but payers can also use this newly available information to their...

Higher Market Share Helps Payers in Negotiations, Premium Impact Unclear

by Kelsey Waddill

Payers with larger market shares tend to have lower prices nationally, a study published in Health Affairs confirmed. The researchers used data from Turquoise Health, a company that collects hospital...

Employers Juggle High Healthcare Spending, Hiring Challenges in 2022

by Kelsey Waddill

Employers are looking for answers as they face an ever-steeper healthcare spending trajectory and hiring challenges in the post-pandemic environment, according to a survey from the National Alliance of...

Consumers Seek Transparency Around Treatment Costs, Healthcare Deals

by Kelsey Waddill

Consumers voiced their support for more transparency around healthcare costs and deals, with three-quarters of respondents supporting protections against site-based treatment cost increases in an AHIP...

UHC Rebrands Self-Funded Health Plan, Focus on Price Transparency

by Kelsey Waddill

UnitedHealthcare has announced that it has rebranded its self-funded health plan option, which will now be called Surest but which will maintain its focus on price transparency and...

More Consumers Find Transparency Tools Accessible, Useful in 2022

by Kelsey Waddill

More consumers reported that their health plans are offering transparency tools and overall consumer awareness about the availability of transparency tools has grown, according to a study conducted on...

9 Employer Best Practices for High Deductible Health Plan Design

by Kelsey Waddill

Employers are exploring ways to promote effective high deductible health plan benefits utilization among members, as noted in a report from the National Pharmaceutical Council (NPC) and...

Oscar Health Cost Estimator Tool Aims to Increase Price Transparency

by Victoria Bailey

Oscar Health has launched an updated cost estimator tool to increase price transparency around healthcare costs and help members plan for their medical bills in advance. “Since day one, Oscar...

ACHP: Extend Transparency, Interoperability Compliance Deadlines

by Victoria Bailey

The Alliance of Community Health Plans (ACHP) has asked CMS to reassess surprise billing, cost transparency, and interoperability compliance deadlines and health data exchange policies that are putting...

How Payers Can Prepare for the Payer Price Transparency Rule

by Kelsey Waddill

Payers should prepare for the payer price transparency rule to go into effect by building clear communication paths with members, reassessing their contracting processes, and asking themselves a couple...

Payers Denied 17% of 2019 In-Network Claims on ACA Marketplace

by Kelsey Waddill

Certain Affordable Care Act marketplace policies need to be tweaked in order to support greater consistency across transparency data reporting processes, a recent Kaiser Family Foundation...

Surprise Billing Law Covers Contract Disputes, Price Transparency

by Kelsey Waddill

Congress has passed a new law that seeks to eliminate surprise billing, particularly surprise bills that result from contract disputes, inaccurate provider directories, and air ambulatory...

Consumers Use Digital Tech for Price Comparison, Virtual Care

by Kelsey Waddill

As the country experiences an enrollment season in the middle of a global pandemic, Americans are gravitating toward digital technology for a wide variety of purposes including price comparison and...

AHIP Issues Criticism on Final CMS Price Transparency Rule

by Hannah Nelson

America’s Health Insurance Plans (AHIP) has come forth with critique of the price transparency final rule, saying that it will drive healthcare prices up and decrease industry competition. The...

CMS Finalizes Price Transparency Rule with Self-Service Tool

by Kelsey Waddill

CMS has released the final rule for price transparency in healthcare coverage, which aims to allow the public to have greater insight into healthcare costs in order to increase value. “This...

What Happens if SCOTUS Overturns ACA, Besides Coverage Loss?

by Kelsey Waddill

Update 11/5/2020: This article has been corrected to state that the Supreme Court will hear the oral arguments regarding the Affordable Care Act’s constitutionality on November 10, 2020. A...

Private Payers Pay Hospitals 247% of Medicare Reimbursement Rate

by Kelsey Waddill

Private payers are paying hospitals 2.5 times more than the Medicare reimbursement rate and employers have a role to play in rectifying the negotiating process, a recent RAND Corporation (RAND) study...

Recent Articles