Healthcare Price Transparency: A Win-Win for Providers and Payers

In the healthcare industry, price transparency is an increasingly critical issue for patients, payers and providers. In the years to follow, the push for transparency will likely continue as there has been increased scrutiny on healthcare price transparency among both policymakers and regulators. Healthcare price transparency is not only important, but advantageous for providers and payers to practice. Even though each group experiences benefits that are exclusive, working together on price transparency helps to improve the patient experience and strengthens the healthcare system.

Regulations on Price Transparency

Before making critical healthcare decisions, it’s vital that patients are provided with all the necessary information. Procedural information is important, but so is the cost of care and accurate price information, evidenced in the Hospital Price Transparency Rule that went into effect on January 1, 2021. The Transparency in Coverage Final Rule (TCR), is another regulation that went into effect on January 1,2023 aimed at helping consumers to make better health care decisions as they are more informed through the accessibility of pricing information.

Price Transparency and Providers

The lack of clarity about healthcare service costs can leave patients feeling confused and with a growing sense of distrust. Transparent pricing information enables providers to build trust with their patients and improve their overall satisfaction. Additionally, providers are motivated to pursue healthcare price transparency for a variety of other ethical and practical reasons. Some include:

• Patient retention
• Lower costs
• Improved value
• Better quality of care

Today, patients are increasingly tech-savvy consumers, relying on digital devices to do comparison shopping for all their needs. In relation to healthcare, it’s fair to presume they will more likely choose providers who are transparent with their pricing. Forthright pricing information allows providers to establish themselves as being trusting and reliable, but it also acts as a differentiator amongst the competition.

Healthcare price transparency can also help providers to lower their expenditures. As billing and collections can drive up administrative costs, by implementing transparent pricing, providers can lessen their burdens in these areas. When it comes to price clarity, patients understanding the costs associated with their healthcare services are more apt to pay their bills promptly. This reduces the need for costly collections efforts and opens the door to improved cash flow.

With patients having access to pricing, transparency can create competition in the healthcare market due to the likelihood of patients to engage in comparison shopping. As competition increases, it can realistically lead to lower pricing and greater value for patients. Providers that offer transparency can position themselves for success and become leaders in the market, attracting budget conscious patients looking for the best healthcare value.

Finally, healthcare price transparency can help providers to improve the overall quality of care they provide their patients. Pricing transparency enables patients to make more informed decisions relating to their healthcare. By doing so, patients can find greater satisfaction, but can also lead them to better health outcomes. Providers can use pricing data to identify trends within their practices but can use it to make necessary changes to improve the value offered to their patients.

The Importance of Price Transparency for Payers

Trust is an important factor when it comes to insurance providers as well. A Ribbon Health survey found that 66% of member respondents would have increased trust in their health plans if they provided better information on providers, with 61% saying that information on cost of care was either “somewhat” or “very” important to them. According to AHIP, as of 2021, nearly 94% of commercial health insurance providers have committed to empowering consumers to make better health care decisions by offering price transparency through cost estimator tools. Payers can use pricing information to help patients find lower-cost providers and to negotiate more practical rates with providers offering higher-valued services.

Apart from managing costs, payers can help to improve the quality of care by motivating providers to offer high-quality, cost-effective services. By using pricing information, payers can more easily identify fields where providers are offering low-value or needless services, and act to lower costs, but maintain quality.

Member satisfaction is important to payers and price transparency can help them to improve contentment among its members. When patients are informed, they feel more empowered to make decisions about their healthcare, leaving them with a greater sense of satisfaction about their coverage. Payers offering price transparency are more inclined to retain and attract new members that see value from their healthcare coverage.

For payers, healthcare price transparency can help to reduce fraud. With access to pricing information, payers are more prone to recognizing and preventing billing fraud. They can be a leader in the healthcare system, protecting its integrity from providers charging higher prices than normal or those who practice deceptive billing.

Lastly, one of the biggest issues today for payers is regulatory compliance. Payers offering transparent pricing are demonstrating their continued commitment to compliance with regulatory requirements. This helps reduce the risk of penalties or fines they can incur for non-compliance.

Working Together to Increase Value

Healthcare price transparency is an important issue for both providers and payers. For providers, it can help to improve trust and satisfaction, attract and retain patients, lower expenditures, and reduce costs associated with healthcare services. On the payer side, in addition to complying with regulatory requirements, price transparency can help to manage costs, increase member satisfaction, and reduce fraud and abuse. Payers can work with providers and stakeholders alike to create new ways to increase transparency that result in greater value to patients, thus improving the healthcare system as a whole.

Apexon drives innovation where it has the greatest impact by applying a digital first approach across the healthcare spectrum. Apexon helps companies to streamline operations and lower costs. To learn more, check out Apexon’s Digital Healthcare Software Solutions & Technology services page, Apexon’s healthcare success stories, or get in touch directly using the form below.