ClaimLogiq IQ Insights

Read our experienced team's thought leadership and insight for all areas regarding healthcare claims auditing, payment integrity, provider relations and cost avoidance.

All Posts

Healthcare Price Transparency - What are the costs?

What are the costs for payers, providers and patients in moving towards a historic healthcare price transparency model?  We know that payers and providers negotiate specific pricing tiers and strategy regarding both small and complex healthcare visits and procedures, but, what would that look like up-front to the patient?


When a behemoth industry like the US healthcare industry, has functioned for decades in a non-transparent fashion when it comes to healthcare pricing, what are the hurdles that face payers and providers?  At what cost will these new price transparency measures deliver to patients and what will the impact be of trying to essentially "reverse" an infrastructure the US Healthcare system has been based on since, inception?


Healthcare Price Transparency Hurdles

Hurdles to becoming totally price transparent include:

  • Healthcare cost disparities
  • Patients and affordable care
  • Price accuracy and consistency
  • Payer and provider relationships
  • Quality transparency

Healthcare Price Transparency Modern Healthcare Quote

When the average healthcare cost disparity can be up to 300% difference between the lowest and highest charge for a procedure, the differences in pricing present the first hurdle.  Costs must first have common, core structure that can be applied to all visits and procedures.  This is am important first step in closing that cost disparity gap to arrive at price transparency.  Costs for vists and procedures must be on the "same page", in order to provide an applicable cost to patients. 

Patients employ varying methods in seeking affordable care.  Choosing a type of care or provider influnces the impact of healthcare pricing for each patient and for each plan. When care can be equally distributed and access to appropriate care, costs can be aligned and, eventually, transparent.

Price accuracy and consistency is a known challenge, according to Modern Healthcare: "It’s tough for a provider or an insurer to come up with an accurate cost estimate for a particular service. There is no standard price for a knee replacement, an angioplasty or any other healthcare service. Prices can vary by thousands of dollars between hospitals within the same neighborhood, let alone in different parts of the country."

But what about payer and provider relationships?  These relationships are intricate, complex and always evolving at the demand of an industry that is always pushing for change.  Payers and providers must carefully navigate relationships in order to arrive at price transparency to delivery optimal payment integrity that not only benefits the patients, but, the future of payers and providers to continually offer the very best healthcare.

Lastly, price transparency is almost irrelevant without quality of that transparency.  What kind of care will patients receive for that price?  Will a lower price drive a lower quality of care? Perhaps a higher price might indicate, better, more thorough healthcare?  Price transparency also needs quality transparency, without those two together, price transparency alone might have the opposite intended effect on healthcare and the industry.

Knowing the challenges and roadblocks these hurdles can present, it's imperative that payers, providers, legislators and patients remain proactive and actively engage in all discussions as we unite to lower healthcare costs for all.

Remaining Ahead of the Price Transparency Wave

When the costs of conducting healthcare business have never been consistent across providers and plans, let alone transparent, the challenge will be akin to climbing a mountain, perhaps more than once!

CLQ.Climbing a Mountain.

Payers, patients and providers must begin to understand the complications of achieving price transparency and the journey that is ahead.  Not only will untangling the complexities of the healthcare industry that is already happening deliver a clear path towards price transparency, but also partnering with organizations that are capable of navigating this journey will be a integral part to the breakthrough for total healthcare price transparency.

ClaimLogiq is uniquely positioned to partner with payers on this journey, by providing insight, guidance and expertise backed by years of an innovative approach to healthcare claim auditing.  As the industry starts to conform, step by step, it is important the right partnerships are chosen in order to correctly postion payers to best serve provider and patient relationships.

"Transparency is at the core of our business. This is evident as our comprehensive software solution is uniquely payer-facing  - this allows insight, control and total transparency over the claim lifecycle. This transparency and control allows clients to be agile within the healthcare industry and move at a faster pace without compromise in accuracy or consistency when it comes to payment integrity.  ClaimLogiq is therefore best positioned within the market, with this particular strength, as a business partner, to help payers and the industry make this monumentous change in providing higher quality healthcare for all."

-Todd Hill, CEO and Co-Founder, ClaimLogiq

Contact a ClaimLogiq team member today to discuss options in co-navigating this healthcare industry evolution, together.  We make your challenges, our challenges, because to us - it's personal.



Rebecca L. Price
Rebecca L. Price
As the Director of Marketing, Rebecca leads the strategy for ClaimLogiq communications and engages with ClaimLogiq's audience through social media and other digital platforms. Rebecca has decades of experience writing about software and technology and has produced informative healthcare innovation materials in the form of white papers, print and video content. Rebecca studied Integrated Strategic Communcations and holds a bachelor’s degree from the University of Kentucky.

Related Posts

Industry News: COVID-19 Impact on Employer Health Plans

The impact of the pandemic hasn't been a ripple effect, it's been more like a shockwave to the healthcare industry, insurers and employer health plans (just to name a few in the payer space). It's safe to say no matter who you are, there is an immediate visceral reaction to the impact "Coronavirus" or, "COVID-19" is having on lives, every day. Specifically, the impact on employer sponsored health insurance plans revolves around massive job losses and, although the immediate affect has been staggering, as we enter the second half of 2020, there appears to be some up-ticks in positive notes about the still, very challenging road ahead.

What will Telehealth look like after COVID-19?

COVID-19 caused a drastic decrease in in-person care. Nearly overnight, anyone displaying symptoms of the virus was urged not to walk into their medical clinic without calling ahead and making sure it was necessary. With COVID-19, suddenly, telehealth was more necessary than ever before. So – where do we go from here? If this is the new normal for doctor’s visits, is it good enough? How do we make it better? And how?

Industry News: Health Insurers Call on Congress to Provide New Funding

Industry News: Health insurance companies are calling on Congress to provide more funding to help people keep coverage, citing the more than 44 million who have filed for unemployment since the coronavirus crisis started. The two main health insurance lobbying groups, America’s Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association, wrote a letter to congressional leaders on Friday making a range of requests for the next coronavirus response package, expected later this month.