News 6/25/2021 How Employers Can Push The Needle In Health Care Transparency

Transparency has been a tug-of-war in the health care world for years. While the government, employers and consumers alike push for more insight into pricing, the health care industry has, in general, responded with lawsuits, lobbying efforts and minimal compliance with regulations. However, new (and pending) federal regulations—and increased enforcement of those regulations—have the potential to turn the tide.

Employers can use the data derived from the current federal rules affecting health care systems and hospitals to refine their networks and negotiate discounts; can educate their employees on how—and why—to use health care pricing information and how it can save them money, and start preparations for compliance with the regulations affecting them beginning next January.

1. Make Health Care Transparency a Priority

When employers and their employees can see what services actually cost, both can have more control over their out of pocket costs and make better financial decisions. That’s why it’s important for employers to keep a close eye on trends in the health care transparency space. With access to this information, employers can compare prices among hospitals in the same area and better drive network and plan negotiations, as well as steer employees to use lower-cost facilities.

Health care transparency also greatly improves employees’ health care spending. With access to pricing information, consumers have a better idea of what they can expect to pay for a medical procedure—enabling meaningful conversations with their doctors about potentially less expensive alternative tests or treatments, a choice of a lower-cost provider and/or the opportunity to review payment options. That said, access to information can only take employees so far.

2. Invest in Employee Health Care Literacy 

Half of U.S. consumers don’t understand the basic concepts in their health plans, according to DirectPath’s 2020 Consumer Report, and even fewer know how to apply cost information to their personal situation. Employers can’t expect employees to shop for health care if they have low levels of health care literacy. Support and education will be needed to ensure employees can take advantage of the information made available by the new transparency requirements.

Too often, employees try to self-educate when it comes to health care – exploring online resources or asking friends, family and coworkers for guidance. To ensure that employees receive accurate information about the plans and programs available to them, employers should offer one or more of the following resources to improve employees’ health care literacy:

  • Benefits educators –to help employees choose the benefits package that best fits their needs. During open enrollment, benefits educators review employees’ current elections, answer personal questions and explain key health care terms and concepts. One-on-one sessions, whether in person or telephonic, make sure employees select the benefits and programs that deliver the optimal coverage for themselves and their families.
  • Health care advocates –provide year-round support as employees seek second opinions, grapple with claims issues or shop for the lowest cost procedures. By answering employees’ questions in real time, advocates can help employees make the most of their coverage.
  • Transparency services –to demonstrate the importance of shopping for care. Trained advocates provide side-by-side cost comparisons for services so employees can see firsthand how dramatically their costs can vary from one provider to the next and make an educated decision about where to receive care. Through this practice, employees get into the habit of comparing costs, and ultimately reduce their out-of-pocket spending.

Employers should be investing in employees’ health care literacy – because when employees save money, so do their employers. As more regulations are introduced that will affect employers and plan sponsors, employers should get ahead of low health care literacy – and cost containment –by educating their employees (and their families) sooner rather than later.

3. Step Up to the Plate

Clearly, employers have an important role in supporting health care price transparency, from making it clear to carriers and local providers that they expect compliance with existing federal and state regulations, to educating employees on the whys and hows of shopping for health care.

But, come January 1, employers will need to take a more direct role in supporting health transparency, as the Transparency in Coverage rule imposes new requirements on group health plans (and insurers). The first phase entails public, online disclosure of health care pricing, including in-network-provider-negotiated rates for covered items and services, historical billed and allowed amounts for covered out-of-network providers and pharmacies, and negotiated rates and historical net prices for in-network prescription drugs. More personalized data will be required in 2023 and 2024.

Consumers may feel there’s nothing they can do to control their health care expenses – but that doesn’t mean employers can’t help. If employers choose to step up, provide the information and education employees need, and strategically work with nearby providers, employees will be able to own their finances and health. Sometimes the biggest changes start at the individual level, and when it comes to health care transparency and literacy, this has never been truer.

Read the article here.

(Kim Buckey, Vice President, Client Services at DirectPath)

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