"You get what you pay for" is a well-known axiom, but it has been a nonexistent concept in the health care industry for decades. Health plans have treated their reimbursement schedules as  a trade secret, and the federal government historically prohibited price transparency under the Sherman Act. 

The fact that the Centers for Medicare and Medicaid Services (CMS) now compels health plans to post negotiated rates is a sea change. With health plan pricing transparency, understanding value — the intersection of the cost and quality of a health care service — is possible, creating a potential game-changer for health plan sponsors, including employers, who were formerly in the dark. In turn, "bending the health care cost curve" is now not only possible, but also urgently needed. Ensuring that employees make informed choices about value is the only way for employers to receive "value for money" for their health care expenditures. 

Transparency tools shifting locus of competition

Employee health benefits represent one of the biggest line items for employers, with premiums and deductibles rising at almost every company, regardless of size. Suddenly, on the heels of landmark federal and state regulations that enforce transparency in pricing and quality data, it's also one of the ripest cost centers for disruption. 

Continue Reading for Free

Register and gain access to:

  • Breaking benefits news and analysis, on-site and via our newsletters and custom alerts
  • Educational webcasts, white papers, and ebooks from industry thought leaders
  • Critical converage of the property casualty insurance and financial advisory markets on our other ALM sites, PropertyCasualty360 and ThinkAdvisor

© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.