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
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!
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.