Transparency. The topic seems to come up in every sentence within the healthcare benefits space today. With CMS recently rolling back payment penalties, the question that most of our partners are asking; what does this mean for my business and how can I effectively roll this out to our groups and members?
Based on the latest guidance, in 2023 insurers must offer tools online that show the OOP estimates for a list of services that CMS deems “shoppable”. What we are all asking ourselves from a marketing perspective is what does that really mean and how will this be understood by those that don’t live in a world where Allowable Amounts and Provider Contracting is common vernacular.
Here are four takeaways that you can do to make this transition as simple as possible for your groups and members and avoid customer service nightmares.
Educate First
Health insurance isn’t fun for most people. Recent stats show 96% of the US population can’t define the top five healthcare payment terms that we use nor understand what it means. Can you imagine trying to explain to the general public how in and out of network pricing work and PBM rebates? As a benefit payer, the best thing you can do is walk people through the comparison process and what their expected expense means. This will take numerous and repetitive touchpoints. Video is a great tool to communicate education in digestible format. Think pictures rather than words to help them understand and apply the information.
Prepare for Questions
The news media and other parties are going to look for the 600% pricing differential from hospital X to hospital Y guaranteed and run stories on it. Use this as an opportunity to be a guest speaker on stations or publications to position yourself as the subject matter expert. Explain the way the system works, how pricing differences can occur and what you are trying to do to bring the best value to your groups through negotiations or case agreements. Can’t make the news? Make your own through channels like webinar and LinkedIn live to answer audience questions.
Gather Your Data
This is no doubt going to be a cumbersome process and take many long hours for your organization. This may mean new reports, new plug-ins and maybe even an entirely new enterprise software. With most TPAs using rented networks, the big guys should have this setup. But, what about the situations where you have smaller EPOs or Narrow Networks? This can create a massive opportunity for you to show groups why the smaller network is every bit as strong as the large national network to further prove your point that bigger numbers may not necessarily be right for them. Position this in your proposals and selling materials accordingly.
Expect for New Options in Your Plan Designs
For many years working in the carrier space, the main reason people chose a national carrier was their network adequacy. Here’s your golden opportunity to show real world numbers and new network options to a group that has been only concerned with the number of hospitals or doctors. Personally, I think this will present a massive opportunity for TPAs to communicate their value and flexibility compared to the national carriers. You have choice for every group, whereas Carriers are only equipped with their one option. This positions you as the truly flexible option in an even greater way if your materials and communications can convey this.
Final Thoughts
We all know that there have been versions of transparency tools available for years to users, and from what I have always observed, they simply are only used by a small segment of the population.
With recent lawsuits from the U.S. Chamber of Commerce and the Pharmaceutical Care Management Association, will this be pushed back further or will this be delayed indefinitely?
One concept reigns supreme; maximize your connection with brokers, groups and members and educate them as soon as possible. Be their source for information and help them navigate what the future looks like, rather than waiting for someone else to do it.
In an Amazon world where everything is in front of you by a simple web search, can this be achieved and will it create more problems than benefits. The jury is literally still out.
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