Delay to Price Transparency Mandate. No Surprises Act (NSA) and Transparency in Coverage (TiC). Machine-Readable Files. Self-Service Price Estimation Tool. HealthSparq.

Extracting Strategic Value from Delay to Price Transparency Mandates

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Staying on top of government regulations and their compliance is an ongoing reality for health plans, health systems, and care provider organizations operating in the healthcare industry.  And oftentimes when federal agencies issue a delay in enforcing new regulations many organizations breathe a sigh of relief – and then fail to take advantage of the extended time to take a more strategic approach. Recently some healthcare organizations took that sigh of relief as new guidance was issued related to the No Surprises Act (NSA) and Transparency in Coverage (TiC) health plan price transparency mandates. Among other areas, these changes impacted Machine-Readable Files and the Self-Service Price Estimation Tool. Here’s an opportunity to add more value than merely ‘checking a box.’

Enforcement of Machine-Readable Files Delayed

Enforcement of the requirement to post in-network and allowed amount (out-of-network) Machine-Readable Files (MRFs) has been delayed from January 1, 2022 to July 1, 2022. And the Rx pricing MRF is on hold until further rulemaking is completed. See this post on Diving into the Details: What You Need to Know About the Machine-Readable Files Mandate

Self-Service Price Estimation Tool – Additional Time of Deliver Strategic Member Experience

CMS resolved the conflict between requirements under the No Surprises Act to provide a price comparison tool by 1/1/22 and Transparency in Coverage to provide an internet-based self-service tool by 1/1/23. Accordingly, CMS will now defer enforcement of the NSA requirement to make a price comparison tool available until 1/1/23.

Opportunity to Leverage Delay of Price Transparency Mandate – Challenges, Issues, & Opportunities

Smart health plan leaders will take advantage of recent delays to differentiate their organizations beyond merely ‘checking the box’ of government compliance. To help with that approach, the HealthCare Executive Group has hosted two Focus Area Roundtable on Price Transparency and has a 3rd opportunity for health plan leaders to differentiate their organizations beyond merely “checking the box” but rather taking an approach to improve the overall experience of their plan members.

On Thursday, September 23rd at 4:00 PM ET, our Focus Area Partner for Price Transparency HealthSparq will facilitate the 3rd Focus Area Roundtable. In this discussion, the following topics will be discussed:Delay to Price Transparency Mandate. No Surprises Act (NSA) and Transparency in Coverage (TiC). Machine-Readable Files. Self-Service Price Estimation Tool. HealthSparq.

  1. How have you adjusted your plans based on CMS’ recent changes regarding the delivery of Machine-Readable Files?
  2. What are the challenges you are encountering regarding compliance with and/or strategically positioning your price comparison tool(s) beyond just a ‘check the box’ approach?
  3. Who’s driving the process to comply with and/or strategically position your price comparison tool requirements?

Opportunity to Meet Others & Ask Questions of Experts on Price Transparency

Our Focus Area Roundtables are 45-minute sessions where all participants get to introduce themselves, meet others dealing with similar challenges, issues, and opportunities, and ask questions of experts intimately involved with addressing specific priorities. Read the recaps of earlier price transparency roundtables here, here, and here and check out upcoming roundtables on other priorities identified by healthcare executives and consider joining those roundtables.

Payer-Provider Collaboration Critical to Meeting Price Transparency Mandates

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  • Ignoring price transparency mandates will not make them go away

  • Will the No Surprises Act be the dagger in the heart of fee-for-service payments?

  • What changes to the No Surprises Act may be coming? And when?

  • Will Advanced EOB’s force payers and providers to collaborate more?

  • How might price transparency impact the workflow of health plans and providers?

  • Will price transparency regulations help patient engagement? Or create a customer service nightmare?

Our second Focus Area Roundtable on Price Transparency – facilitated by HealthSparq – took place on Wednesday, June 16th and members of the HCEG Network and industry thought leaders including Denny Brennan, Executive Director and Chief Executive Officer of HCEG partner Massachusetts Health Data Consortium (MHDC), raised and explored these and other questions.

Ferris Taylor kicked off the roundtable by asking Matt Parker, Vice-President of Products at HealthSparq, to frame the conversation by sharing a highlight of the keynote presentation “Path to Transparency – Increasing Access, Lowering Costs, and Driving Value that Matt presented along with two other healthcare leaders at the World Health Care Congress Virtual 2021 conference.

Price Transparency – Part of the Foundation for Patient Engagement

Matt Parker related that the Transparency in Coverage Mandate and No Surprises Act presents unique challenges for health plan payers and providers that can only be addressed via increased collaboration. Matt shared that price transparency is just a tool, a component to facilitate payer and provider interaction with their members and patients – not an end in itself but rather something for helping members, patients and providers better understand available provider networks, find care when they need it, engage with the system, and understand what costs are going to be – from both the member, patient, and provider perspective.

Matt suggested this price transparency foundation is the floor on which health plans and providers can build more holistic engagement with their members and patients.

RELATED: Recap of 1st Focus Area Roundtable on Price Transparencyhealthcare transparency in coverage. No surprises act. healthsparq price transparency

Building Upon the Floor Established by Price Transparency Mandates

To build upon the idea of compliance with transparency mandates as the floor, a health plan participant asked: How do we separate the basic needs of meeting the mandate from the next phase once pricing data is out there? And once basic needs are met, how can we then use that accomplishment to do things to support our members to engage with our providers more effectively? How can we help members with their provider relationship?

These few questions and others raised by participants affiliated with both health plans and provider organizations shaped the discussion and interaction throughout the roundtable.

Primary Topics Discussed by Roundtable Participantshealthcare data interoperability surescripts focus area roundtable HCEG

Our Focus Area Roundtables are informal discussions where all participants can contribute insight and raise questions. This post presents a number – but not all – of the contributions made by roundtable participants. Additional content will be shared in future posts, our social channels, and in future roundtables. To receive additional information on this and other Focus Area Roundtables, join our newsletter, follow @hcexecgroup on Twitter, connect with us on LinkedIn, and consider participating in upcoming roundtables.

RELATED: Join our Interoperability roundtable on July 20, 2021 at 10:00 AM PT / 1:00 PM ET

Who’s on First? Low Levels of Initial Compliance Due to Confusion?

One participant referenced a recent study published by JAMA that noted low compliance with the price transparency mandate by hospitals. In response, another participant noted that at his health plan, there was confusion about what is required and who is responsible for compliance with current price transparency mandates.  He noted that some staff were not aware of the upcoming January 2022 price transparency deadline for health plans, or thought it was provider-related, not health plan-related.

To be clear, while there are price transparency mandates for both providers and health plans, the JAMA study referenced the hospital-related mandate effective earlier this year on January 1st. Effective dates for price transparency-related mandates for health plans and the specific capabilities required are noted in the following table:

Transparency in Coverage Mandate – Health Plan/Payer

January 2022 Public access to pricing data through machine-readable files
January 2023 Personalized, out-of-pocket estimates via online, self-service tools
January 2023 Pricing data available for 500 services
January 2023 Pricing data available for all covered services via online tools or print delivery

No Surprises Act – Health Plan/Payer

Cost-sharing price comparison by phone or internet for specific service/item
Advance EOB w/ provider and contracted rate for in-network services. Out-of-pocket cost estimate for Out-of-Network services at least 3 days in advance
Provider directories updated & verified every 90 days w/ info updated within 2 business days of receipt. Health plan process for organizations not responsive to verification attempts.
RELATED: Diving into the Details: What You Need to Know About the Machine-Readable Files Mandate

Ideal Outcomes of Payer-Provider Compliance with Price Transparency Mandates

From a health plan perspective, compliance with price transparency mandates should help providers deliver care more effectively – as viewed by the patient. From the provider’s standpoint, a tighter integration with their health plans should enable providers to answer pricing questions from their patients.

If Mandates are Ignored, Will They Go Away – Or At Least Be Delayed?

Transparency in Coverage Mandate and No Surprises Act

MHDC’s Denny Brennan shared how some provider and payer organizations are viewing the mandates:

‘Perhaps there’s a bit of willful denial about sharing data partly driven by the fact that pricing information has long been held on the provider side in chargemasters, which are notoriously poorly maintained files with respect to what the patient’s actual exposure will be. Providers and plans are still looking at pricing data as part of their proprietary contracting process and may be essentially ignoring the mandate.’

Denny also offered that the idea of sharing pricing data hasn’t settled in across the industry because health plans are waiting for providers to take the lead and many providers are thinking: “We don’t know how to do that, we don’t know if we want to do that, and if we pretend it’s not happening, it may go away – especially because so many things have been pulled back with COVID-19.”

RELATED: Meeting Transparency Mandates: Put Your Employer Groups at Ease

Delays to No Surprises Act – Likely Clarified by August 2021

Ferris asked HealthSparq’s Matt Parker if he anticipated that the payer-side legislation might get delayed. Matt stated that while the Transparency in Coverage rules are finalized in theory, will take place over the next few years as defined, and will likely not be changed, there are not any sufficiently defined rules pertaining to transparency-related parts of the No Surprises Act – including the Advanced EOB requirements.  Matt also shared that updates to the No Surprises Act are likely to be released next month in July.

Listen here for more on potential delays to the No Surprises Act.

Other Mandates Taking Precedence over Transparency?

Participants noted that other regulations, mandates, and rules are taking precedence over – or at least complicating compliance with – the Transparency in Coverage Mandate and No Surprises Act including:

An Old Cliché Rings True: Garbage In – Garbage Out

One participant with decades of experience serving health plans noted that 80-90% of medical bills have errors of some type and this means that price transparency and data sharing mandates are starting from a system that is already error-laden. Accuracy needed to automate information interchange does not always exist and we have to clean up our act before we put it on stage.

She echoed questions posed by her clients:

  • Where am I going to pull this data from?
  • How am I going to get this out of my systems into data files?
  • Who are knowledgeable partners that can help with the generation and hosting of machine-readable files?
RELATED: Understanding the Transparency in Coverage Mandate

Health Plans as Definitive Sources of Health Information

On the topic of who’s best positioned to serve the information needs of members and patients, Denny shared that:

“What we’re telling our members is, and this is a tough message for the provider community, is that the route by which patients/members/consumers will be getting their health data is through their health plan. And the regular interchange and exchange of data between health plans and providers is great for providers who need to manage care. But providers are not envisioned in the rules as being the definitive source of patients/member/consumer health information – that’s going to be coming through their health plan.”

Incomplete and Insufficiently Specified Rules Hamper Meaningful Transparency

Healthcare data includes administrative, clinical, and financial data held by both providers and health plans and subject to HIPAA and other federal and state regulations. Denny shared his take on challenges health plans and providers are encountering due to insufficiently detailed regulations and unresolved elements of payer-provider-consumer interoperability for the purposes of value-based care.

Listen here for more on considerations regarding the current state of interoperability rules.

Advanced EOB’s – Forcing Payer-Provider Collaboration & Impacting Workflow Providers?

Providers need to be able to sufficiently integrate with health plans to get a fairly accurate estimate of the cost of specific procedures. Matt shared his take on the Advanced Explanation of Benefits (EOB) portion of the No Surprises Act and suggests it will force payers and providers to create a technology solution in their workflow.

Listen here for more on the impact of Advanced EOB’s.

RELATED: Advance EOB, Patient/Consumer Protections, and Reporting

No Surprises Act – The Dagger in the Heart of Fee-For-Service?Price Transparency Mandate Kills Fee-for-Service Payment. Value-based payment models

MHDC’s Denny Brennan shared his take on how the movement to more transparency and interoperability mandates may speed the movement to value-based payment arrangements.

“One of the things that I infer from these discussions is that the No Surprises Act is almost a forcing function. As I’ve said to members of our group, if there was ever a dagger, that could be driven into the heart of fee-for-service medicine, it’s the No Surprises Bill. Because in order to prop this thing up and to burden the physician with telling the patient at the point of care that: “Well we want to get you an MRI but if we get it down the street instead of in our own network you’ll save more money.” And physicians hate that. They don’t want to have those conversations. It’s hard enough to get physicians to talk about social determinants of health.

Listen here for more on the potential impact on fee-for-service payment models.

Impact of Increased Transparency on Customer Service

In response to participants’ discussion about transparency mandates forcing greater adoption of value-based care models, Ferris asked whether there might be a consumer backlash based on missing or inaccurate pricing information and how it might be solved. One participant predicted a customer service nightmare for health plans and providers, and another stated that it’s a problem that is going to be solved by a crowd – not by individual organizations.

Listen here for more on the potential impact of mandate compliance on customer service.

RELATED: Price Transparency Resources for Health Plans

Connect with Others Facing Similar Challenges

Special thanks to Matt Parker and HealthSparq for their role as our Focus Area Partner for Price Transparency. For more information on the meeting and exceeding price transparency mandates and to learn more about topics presented in this post, check out HealthSparq’s website and contact HealthSparq here.

If you’re a leader of a health plan, health system, or hospital/provider organization, consider joining future Focus Area Roundtables on Price Transparency, Interoperability, NextGen/Value Payment Models, and Healthcare Policy & ACA. We have other Focus Areas of the 2021 HCEG Top 10+ under development.Healthcare Executive Group Focus Area Partners HealthSparq Softheon Surescripts Zelis

Price Transparency Compliance Regulations Mandates. Policies, programs, and tools. Data standards. Operational considerations. Increasing adoption. End-user education and support. Payer-provider relationships.

Beyond Price Transparency Compliance – Stakeholder Thoughts – Part 2

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The Transparency in Coverage Mandate and the No Surprises Act are forcing health plans, health systems, healthcare providers to focus their attention and already overburdened resources on price transparency compliance-related activities. While price transparency mandates and regulations are intended to help make healthcare better and more cost-effective for health plan members and healthcare provider’s patients, there are strategic and tactical reasons to holistically address the following aspects of price transparency:

  • Policies, Programs, & Tools
  • Data Standards, Data Collection & Operational Considerations
  • Increasing End-User Adoption
  • End-user Education & Support
  • Payer-Provider Relationships

In the first post of a two-part series, Healthcare Price Transparency – Leaders Share Insight – Part 1, highlights from our first Focus Area Roundtable on Costs & Transparency held on April 5, 2021 were shared. HCEG members working for health plans, healthcare providers, and healthcare-related technology/service organizations shared their responses to some questions presented by Andy Hoffman and Matt Parker, two thought leaders with our 2021 Focus Area Partner for Costs & Transparency: HealthSparq.

Stakeholder Adoption, End-User Support, & Payer-Provider Relationships

In this second post, comments and insights from Focus Area Roundtable participants on the following aspects of price transparency are presented:

  1. Increasing stakeholder adoption of price transparency tools and services
  2. The importance of end-user education and support
  3. Payer-provider relationships to support access to price transparency information

RELATED: Understanding the Transparency in Coverage Mandate

Increasing Stakeholder Adoption of Price Transparency Tools

I think the concept of just being a liaison will go a long way on either side through this process. (Health Plan)

Go into the prescriber’s workflow with price transparency, going to the physician’s workflow with pricing information that not only saves the system money but that directly affects the consumer in a way that is frictionless. (Industry Analyst)

Whenever these conversations come up, taking a step back and saying [asking] Who’s going to benefit the most? And by that, I mean not just like the individual or the entity but the health system at large. If it doesn’t really waterfall to the whole cost of care and care opportunities, then we’re probably just clogging up the system. Who’s this going to piss off? Who’s going to lose from that deal? Companies taking rebates are going to lose. Companies overcharging and hiding pricing are going to lose. Intermediaries who aren’t necessary may lose. (Industry Analyst)

We’ve kind of assumed that we have to have all of these systems connected and all this interoperability wired in order to do that. But I’ve seen some really successful approaches and getting information into the decision maker’s hands that benefits the end consumer of health. (Industry Analyst)

Take something like hip and knee replacements. There’s an awareness of ambulatory participation, acute participation, post-acute participation on a couple of levels whether that’s brick and mortar and or home on the post-acute side. (Technology Provider)HCEG Focus Area Roundtable. Costs & Price Transparency. Compliance Regulations Mandates. Policies, programs, and tools. Data standards. Operational considerations. Increasing adoption. End-user education and support. Payer-provider relationships.

Health Plan, Health System, & Healthcare Provider Leaders – Click on the Above to Join a Focus Area Roundtable

Importance of End-User Education and Support for Price Transparency

Price transparency has different meanings to different people depending on their roles and expectations. (Provider)

I think hospitals will have to somehow educate patients and that can come in different forms. And whether it’s on a one-on-one setting or more about broader communication, there is an element of patient education that will need to happen. It’s going to be a lot more complex because it’s going to also have to account for the impact of the health plan. So, the education component is going to be large. (Industry Analyst)

I think the reality is most of us don’t really want to solve the problem in terms of us being the recipient of care. So, if I’m a patient, member, consumer, employee, I want the system to fix these things. I want my health plan that I signed up for to be smart. I want my doctor to have information and just do stuff that doesn’t cost me excess money. I want my pharmacist. (Industry Analyst)

We’re in rural areas so that’s a big, big challenge for us. But what does it mean to the consumer? Do they think that when they go in and try this tool that they’re going to understand precisely what the cost of their knee surgery is? And then is it going to be a big dissatisfier when they learned that surgeon had to do something more, or it was more complex than they originally thought? And as a result of that, they disengage. So, will this help or harm them? (Health Plan)

And then there’s the component of things that even an educated consumer might not know about like the anesthesiologist in the acute setting which rarely gets talked about. And then a bill shows up, let alone the medications that are incurred post-acute. (Technology Provider)

We also have a couple, sort of, denominators there. Am I able to figure this out on my own? Do I have search skills? And EOB skills? And ICD-10 code skills? And then the other is: Am I on Medicaid or sort of a capped model where what do I care about the price? (Industry Analyst)

Patient-Physician Relationships May Offset Price Transparency Benefits

I think it’s a personal thing. For surgeries you develop a relationship with your physicians so even if you see a great price somewhere else, I don’t think that people would jump out to go have say like a knee replacement or shoulder replacement or something even more critical with another physician somewhere else. (Provider)

If they have a relation, they tend to sort of stick with what they know. The people that would make the change are not the people that we would see price making the decision from a true consumer choice perspective but those that are just utterly desperate and have, maybe require something that they can’t otherwise get at which is, again, not part of, not really the spirit of the law, per se. (Health Plan/Provider)

RELATED: Healthcare Leaders Focus on Healthcare Policy & ACA

Payer-Provider Relationships Impacts from Price Transparency Compliance

How do you see the relationship between payers and providers in the space of both informing about price transparency but also making sure that the messaging is consistent? Because again, your got contract disputes and a lot of the No Surprise Act is going to come around contract disputes. (Technology Provider)

This [price transparency] could change the relationship between the provider and the payer. And we’re already seeing a lot of movement around mergers and acquisitions and perhaps this would incent that kind of behaviors further – or maybe not. But I think there will be some sort of macro-level impact as this becomes more widespread. (Health Plan)

Well, I think when it comes to that relationship of payer and provider, one key element that’s going to go a long way actually is support. And support probably more for the hospital side because there’s an element of an IT integration of the back end that you have to think about. And how does it all fit together? And what codes they have to integrate through? (Thought Leader)

Join a Focus Area Roundtable – Connect with Healthcare Peers

Additional Focus Area Roundtables on Costs & Transparency – and other 2021 HCEG Top 10+ focus areas such as Healthcare Policy & ACA, Interoperability, and M & A /Joint Ventures, among others – will take place throughout 2021. If you are interested in participating, reach out to us via email or complete this short form to indicate your interests.

To receive recaps of our Focus Area Roundtables and other information of potential use for leaders of health plans, health systems, and healthcare provider organizations, join our newsletter.

Healthcare Price Transparency Price Transparency Regulations & Compliance, Policies, Programs, & Tools, Data Standards & Operational Considerations

Healthcare Price Transparency – Leaders Share Insight – Part 1

By | Events, Focus Area Roundtable, Resources | 3 Comments

Healthcare price transparency has a lot of attention and focus right now, especially in the mandate-driven space. But addressing price transparency via compliance with regulations is just a portion of what health plans and healthcare provider organizations should be focusing on to help make healthcare better and more cost-effective for their members and patients.

In our first Focus Area Roundtable on Costs & Transparency held April 5, 2021, a group of HCEG members working for health plans, healthcare providers, and healthcare-related technology/service organizations gathered to discuss some of the challenges, issues, and opportunities associated with addressing price transparency.

Challenges, Issues, & Opportunities Beyond Price Transparency Regulations

Andy Hoffman and Matt Parker, two thought leaders with our Focus Area Partner HealthSparq, shared a timeline overview of the Transparency in Coverage Mandate and the No Surprises Act and facilitated the following questions:

  • How are you thinking about price transparency within a rather heavily regulated space?
  • What do you see as key issues and risks in the price transparency space? What’s the role of the 80/20 rule?Healthcare Price Transparency Regulations & Compliance, Policies, Programs, & Tools, Data Standards & Operational Considerations
  • How can we really focus on what health plan members and provider patients need to make good health care decisions, knowing that members and patients often have to navigate in antagonistic payer-provider environments?
  • How can we balance supporting patient needs and operate as an ongoing business while also informing people what things are going to cost before they have to spend unlimited amounts of money?
  • What unique challenges or strategies are you thinking about with respect to price transparency? And what opportunities are you looking to take advantage of regarding price transparency?

This post shares insight and information shared by roundtable participants on the above questions pertaining to the following categories:

  1. Regulations and compliance including their importance and value to various stakeholders
  2. Price transparency policies, programs, and tools
  3. Data standards and operational considerations to advance price transparency

A second post highlighting participant responses pertaining to the following categories will be shared shortly:

  1. Increasing adoption and the importance of end-user education and support
  2. Payer-provider relationships to support access to price transparency information
  3. Advancing healthcare price transparency and next steps

RELATED: Healthcare Leaders Focus on Healthcare Policy & ACA

Thoughts on Price Transparency Regulations & Compliance

As a payer and provider, I can look at other hospitals across the state and they’re not even using our latest pricing. They’re just putting something out there to meet the requirement. So, if there’s not consistency in the data, it doesn’t actually help anybody. It just creates profound confusion. (Health Plan/Provider)

Some of the things that I hear my peers talk about is: Are we just solving certain regulatory requirements or are we solving something members think they want but won’t actually be able to use in an effective way?  Or are we on a road to something that will be of value to all the parties involved? (Health Plan)

So, what are the different things people are putting out there? How do we then know this is the best? This is what we should be doing versus this is what we are doing. Because I think everybody is just trying to meet the intent of the law or the letter of the law, but a lot of people don’t know how. And so, I think that’s one of the things that we’ve got to [consider] if there’s anything we can do. (Technology/Service Provider)

These are people who are sick and injured and hurt and need health care. And we’ve got to do our part to help them out and we can do that in a way that drives our overall business priorities. This sets the floor. We talk about these mandates being a floor and you build an experience on top of that that supports your member needs and supports your patient’s needs. (Technology/Service Provider)

So, I think it’s a good thing that the conversation has started. But I think that the end product is going to be significantly different from what it is that we’re looking at this point. (Health Plan)

I feel like the price transparency is just a way to get our prices out there – for the most part as individuals [procedures]. Unless it’s very comparative in descriptions, information is really hard to compare apples to apples between hospitals. (Provider)

Healthcare Price Transparency Policies, Programs & Tools

Whenever I used to roll out tools and or guidance, probably two decades ago and in more than one state, you have to understand the nature of what it is that your end goal is. And sort of work backward from that. But just sort of putting some things out there, you end up getting exactly what you put into it. (Health Plan/Provider)

For a lot of these hospitals, putting out their prices shows major vulnerabilities for them when it comes to inappropriate pricing, when it comes to the contracts that they’re having. It does highlight the contracts that they have with their different vendors. (Technology/Service Provider)

I think some plans are in sort of this game of chicken to some extent because the No Surprises Act isn’t finalized yet. (Technology/Service Provider)

And how can we give voice to that as part of the overall conversation with the administration because I think they’re trying but they’re sort of missing the point. So, I think it’s incumbent upon us as an industry to start to respond back on all of those fronts as to how best to rethink how to do that since it started out previously and it’s been through lots of different iterations. But that lack of standards or consistency is just…(Health Plan)

Price Transparency Data Standards & Operational Considerations

From the payer or provider perspective, without somewhat more explicit data structure guidance across the board, it’s [price transparency mandate] not helpful. (Health Plan/Provider)

We need a standardization so that everybody can follow that. (Provider)

I don’t think you can do comparisons. It’s not the latest data. It’s not even the same from hospital to hospital. It’s kind of all over the place. (Health Plan/Provider)

So as an industry, I think whether that’s vendor-specific or provider, payer, or even consumer, I think I’d like to see a conversation around how do we drive to those data standards? (Health Plan/Provider)

I would agree that the majority of people and hospitals are doing that [trying to comply in good faith.] They don’t collect the data internally in ways that’s terribly helpful. So, to publish it [price transparency information] requires an infrastructure that frankly many of them don’t have in a way that makes it useful as say maybe a payer would. (Health Plan/Provider)

Healthcare is local, that’s very much true. So that’ll impact the dynamics and the impact of what price transparency brings to the table. (Thought Leader)

There are operational challenges that we have to address and plan to address to be compliant with the new regulations that the question becomes: How will this look and feel to the consumer because pricing can vary so significantly? (Health Plan)

One of the challenges that we see when we engage with plans is: Who are the folks and entities within the organization that are trying to solve this problem? We’ve got to get fee schedules from your contracting folks, and you need member eligibility and claims verification. You had to pull all these different systems together and that’s been one of the things we’ve seen as a big challenge – especially with bigger payers, these big vast entities that have to solve these problems with groups that really hardly ever talk to each other. (Technology/Service Provider)

Join a Focus Area Roundtable – Connect with Healthcare Peers

Additional Focus Area Roundtables on Costs & Transparency – and other 2021 HCEG Top 10+ focus areas such as Healthcare Policy & ACA, Interoperability, and M & A /Joint Ventures, among others – will take place throughout 2021. If you are interested in participating, reach out to us via email or complete this short form to indicate your interests.

To receive recaps of our Focus Area Roundtables and other information of potential use for leaders of health plans, health systems, and healthcare provider organizations, join our newsletter.

Using Incentives to Drive Health Care Shopping Behavior – Recap, Recording & Research

By | HCEG Top 10, Sponsor | No Comments

On Tuesday, December 13th, HCEG sponsor HealthSparq presented a webinar on “Using Incentives to Drive Healthcare Shopping Behaviors.” Over 100 individuals and companies registered for the webinar presented by John Surie of M Health and were presented with information from a study commissioned by HealthSparq to explore how how incentives can impact health care shopping behavior.  The graphic-laden presentation offered insight into information that could influence how incentives programs are rolled out by health plans, employers and health systems.

Healthcare Cost Quality Transparency Consumer Shopping Behaviors

Research Survey on Use of Incentives to Drive Healthcare Consumer Shopping Behaviors – M Health/HealthSparq

Some Survey Highlights Include

  • Examples of popular “incentives” include lower premiums, reduced co-pays, cash, gift cards, movie tickets, etc.
  • Cash incentives are most effective but smaller amounts are almost as effective as larger amounts
  • Providing an incentive of some sort has a marked increase (20+%) in encouraging the use of telehealth services
  • Incentives have a strong positive impact on encouraging the viewing of healthcare-related videos Increasing the amount of an incentive had strongest effect in driving choice of a surgical center
  • Cash incentives have a stronger influence on choice of lab & imaging than on choice of physician, which entails a more personal decision.
  • Heavy ‘users of incentives’ were not any more likely to achieve positive outcomes vs. light users
  • Strong correlation btw those who use ‘rewards programs’ outside of healthcare (airlines, grocery, etc.) and reward programs in healthcare

The Recording, The Research and More Insight from HealthSparq

In addition to making a recording of the webinar available here on YouTube, HealthSparq created a summary of the webinar via this blog post. Moreover, HealthSparq is willing to provide speaker John Surie’s complete research paper on the topic presented in the webinar. You can request that research paper here.

If you have any questions about using incentives to drive healthcare shopping behaviors or would like to obtain additional information , please reach out to HealthSparq at 855-SPARQ-IT (855-772-7748) or via their web site. You can also follow @HealthSparq on Twitter.

More for HCEG Members

For the 2017 membership year, HCEG has many additional opportunities for learning, sharing and networking with other healthcare industry executives, opinion leaders, and decision makers. If you’re not a HCEG member and would like more information on becoming a member, please see https://hceg.org/membership/ or contact Juliana Ruiz at [email protected].