Building a better sandwich

Awareness that medical costs are unhinged and uneven is a solid start to inspire action. So now that the symptoms are exposed, what can employers and benefits advisors focus on to build on the transparency momentum and transform the system?

Employers need to be part of the solution. They can demand transparency from insurance carriers and work with payers focused on value rather than volume. And they can explore published rates to compare carriers based on their own employees' utilization data.
Promote primary care. Access to a list of posted prices doesn't make most Americans medical mavens. Health care consumers want someone to help them navigate this complex system, and having a dedicated primary care doctor who knows your history and the nuances of your care needs can eliminate costly repetition, duplication, and unnecessary visits.
Put pricing in perspective. Insurance companies are not always efficient at negotiating prices – and in some cases, can benefit by making more money with higher-priced care. Additionally, providers often lack incentives to compete on price because volume is not tied to performance or value. Benefits leaders and brokers have a responsibility to really dig into what is driving the costs, align contracts to value, and understand how incentives play into the pricing.
Keep patient experience in the equation. The published data doesn't quantify patient satisfaction, continuity of care, provider-patient engagement, or outcomes.
Find the providers who are doing it right. It's not all doom and gloom. There are a number of providers out there focused on the right things, including financial management and data analytics, to inform treatment options and drive toward better performance.

Price transparency is a necessary step in the uphill challenge to change the status quo, but it's just the start. We can make it part of our conversations and negotiations to forge partnerships aligned for a healthier future.

Instant Insights /

Beyond the numbers: Why price transparency isn't the whole story

More From HR Executive

Related Stories

Recommended For You