What does the future hold for health plans? Looking ahead to next year, one key theme stands out: Price transparency.
Starting in January 2022, the No Surprises Act takes effect, requiring health plans to provide price comparison guidance by phone and online tools that allows members to compare cost-sharing estimates for different services. In June 2022, the first Transparency in Coverage Rule compliance deadline takes effect, mandating that plan issuers publish machine-readable files of negotiated rates for all covered items and services. And in January 2023, all plans must make a self-service online shopping tool available to members that provides personalized cost estimates for 500 covered items and services.
From a financial and company reputation standpoint, these price transparency rules are a compliance imperative. But more than that, these regulations present a unique opportunity for payer organizations to gain a competitive edge by leveraging a substantial market shift to guide strategic investments and improvements.
For example, instead of simply publishing static data files with negotiated rate information for public consumption, organizations could choose to develop standardized APIs that facilitate consistent data exchange with technology partners and commercial clients. As a result, plans could decrease operational overhead and transfer data to key business partners more quickly and reliably—not just in support of transparency regulations, but also other programs such as claims adjudication, benefits design, and formulary management.
Likewise, consider the shopping tool mandate. Instead of building a basic web page that serves up required cost estimates and rate information for members, forward-looking health plans could use this inflection point to rethink their provider directory and healthcare navigation experience from the ground up. With member engagement and retention being top business goals, they might choose to invest in a consumer-centered search platform that incorporates not just cost information, but also quality information, provider demographics, and personal member preferences. They might even go a step further, opting for a healthcare guidance platform that directs members to optimal in-network care settings with data-driven recommendations.
This approach to compliance is proactive instead of reactive. It supports bigger-picture thinking that can help plans make progress toward existing goals around member experience, affordability, and health outcomes. And it transforms work that could be viewed as an unavoidable cost center into a strategic initiative that has positive long-term impacts on revenue through reduced healthcare waste, shared savings, and improved client and member retention. With a strategic response to these new regulations, health plans can do more than just satisfy legal requirements—they can begin to change incentives and market dynamics in the healthcare industry for the better.
The author, David Vivero, is co-founder and CEO of Amino.