Delivering ‘no surprise’ Experiences With Price Transparency In Health Care


Delivering ‘no surprise’ Experiences With Price Transparency In Health Care

As the U.S. government issues and clarifies overlapping regulations designed to bring about price transparency in health care, providers, health insurance companies, and self-insured employers must overcome confusion, complexity, and outright concerns just to comply.

Beyond compliance, the second challenge relates to the complex nature of health care, especially how services are priced and paid for in the United States. Full transparency would require hospitals and payers to disclose negotiated contract rates, which the American Hospital Association (AHA) called anticompetitive and America’s Health Insurance Plans (AHIP) said would reduce competition and push health care prices higher. The AHA also pointed out that the complexity of hospital contracting and billing have made compliance with price transparency regulations impractical and often impossible.

The goal of  enabling patients to know more about their health care costs so they can make informed decisions is something most organizations support, including the AHA and AHIP. Price transparency is appealing to most health care consumers and can be useful in decision-making. An IBM Watson Health PULSE Health Poll conducted in August found that 79% of people who successfully find pricing information about health care services use that information to help make decisions about those services.

As payers and providers focus on what price transparency rules mean for their organizations, it is a good opportunity to think beyond compliance. Focusing on improving the consumer experience around costs and billing can deliver vast benefits to the health care ecosystem overall. 

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