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Going beyond healthcare price transparency

October 23, 2020
Sarah Elbert

Healthcare price transparency hasn't had much impact on employee care decisions. So where does that leave employer benefits programs?

As a consumer, you’re used to being able to compare costs for all kinds of products and services to help you make better decisions. But that isn't true of healthcare. Most of the time, you have no idea how much a doctor's appointment or surgery will cost you, or which facilities are more expensive than others.

Trying to find any kind of pricing information to help you choose where to get care is incredibly complicated, time-consuming, and stressful. Just ask Minnesota-based customer service employee Sharika Kurumathur. She recently struggled with infertility and wanted to map out her treatment plan while keeping her costs in check.

First, Kurumathur set up a (pre-COVID) in-person interview with her health plan customer service agent. The agent helped her determine what questions she needed to ask her doctor’s office and how she would know if she’d met her maximum yearly infertility coverage. Kurumathur picked a clinic based on its location, its website, and the fact that they helped walk her through the insurance process. Then she talked to a friend who worked in insurance to help her figure out how the billing process would work. Finally, she looked at her health plan website to research the price of the medicines she’d be taking.

Kurumathur, who now has a 2-year-old son, says that even after finding out the prices at her clinic, she still didn’t how they compared to those at other facilities. She also had no idea if the clinic’s patient experience or health outcomes were good, bad, or average compared to other clinics near her. While Kurumathur was happy with her quality of care, the process of researching and choosing where to get treated was overwhelming—even with help from multiple experts. If you don’t have access to these kinds of resources, it’s even more difficult to figure out which doctor or hospital is the best option.

The push for healthcare price transparency

In recent years, healthcare price transparency—the idea that the cost of healthcare services should be made available to consumers before they get care—has become a topic of focus for policymakers and consumer advocacy groups. The thought is that, if you’re able to comparison shop for doctors and facilities the same way you do for airline tickets or a new TV, you’ll end up choosing lower-cost care options. For employers offering self-insured health plans, price transparency has even more appeal because it could potentially save employees money and reduce claims spending on unnecessarily expensive care.

If you think more access to healthcare price information is a good idea, you’re not alone. A survey conducted by Morning Consult on behalf of America’s Health Insurance Plans found that 82 percent of adults want their healthcare information delivered in a way that’s more concise and simpler to understand. And 66 percent said they would consider seeing a different specialist if they knew they could get the same quality of care at a lower cost.

But there’s a big problem with price transparency that many people aren’t talking about. Once you figure out what your healthcare costs might be—after jumping through a whole bunch of hoops—you still have to determine how these costs compare to prices at other clinics, hospitals, and doctor’s offices near you. Then you have to weigh the costs against other factors, like a doctor's experience treating specific health conditions or a hospital's safety ratings, and make a final decision about where to get care. Layer in other factors like health plan network coverage, procedures involving multiple clinicians, health plan deductibles and coverage limits, location, demographics, etc., and this decision matrix becomes super complex.

It’s no wonder that first-generation healthcare price transparency tools have done very little to change employee choices about where to get care. Providing cost data without contextualizing that information or helping people navigate through it only complicates an already confusing process.

Making price comparisons and smarter care choices convenient for employees

If price transparency isn’t an effective way to help employees make better decisions about where to get care, what is? That’s where digital healthcare guidance solutions can help. These platforms do the hard work of determining which providers are in your health plan’s network and then guiding you to doctors, clinics, or hospitals nearby that can provide high-quality, experienced, and cost-effective care for specific health needs. And they can do it in a fraction of the time that you would spend to do the research yourself.

The key difference between healthcare transparency and healthcare guidance technology is personalized recommendations. For example, Amino analyzes a member’s search term and quickly narrows down nearby doctors who are in-network. It then compares cost and quality data to identify the best care options for the specific condition or procedure the member searched for. These options are clearly highlighted so members can shortcut the research process and quickly find high quality, lower cost care settings.

This is a huge win for employer benefits programs. Not only do healthcare guidance solutions save you and your employees time and hassle when you have to get care—they can also save your health plan a significant amount on claims costs by helping people avoid unnecessarily expensive doctors and facilities, inappropriate treatments, and out-of-network charges.

Giving your employees access to a healthcare guidance platform to make their search for an experienced provider more convenient can pay valuable dividends, especially for those who are managing a stressful medical issue. And it can help you and your employees get great quality care without having to spend hours researching your options.

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