How healthcare price transparency leads to a better customer experience

by Bill Krause

posted on 08-12-2020

Barely a week goes by where we don’t see a news report about a “surprise” healthcare bill.

In January, for example, a 50-year-old Madison, Wisc., woman was charged $41,000 for an air ambulance for seizure treatment. The month prior, a 40-year-old woman from Brooklyn, N.Y., was charged more than $28,000 for an out-of-network throat swab.

To the consumer, these unexpected costs are not only outrageous, they can mean more credit card debt, less cash to pay for necessities, and even bankruptcy. High costs also lead many to “choose” to delay or skip care entirely, according to a Gallup and West Health poll published last year.

Multiple federal and state efforts are working to rein in the occurrence of unexpected costs. Late last year, for instance, the federal government proposed two regulations to take effect next January. One states that hospitals must share all pricing information with consumers, including discounts and deals negotiated with payers. The other requires payers to send information about out-of-pocket expenses to patients before they receive care.

While there may be legal challenges to these proposed regulations, there’s no doubt patients want more visibility into the entire healthcare experience, from pre-care to payment. That means a full understanding, up-front, of their insurance benefits, the cost of services, and, more specifically, what they may need to pay out of pocket.

Consumerization and personalization should support the patient journey

Modern healthcare consumers — used to experiences in the digital retail world — expect a user-friendly way of finding care and comparing services. This requires the ability to search for the best quality and price among providers and pharmacies, as well as the ability to schedule, manage, and pay for care online, including flexible payment options. In fact, a 2018 United Healthcare study found that more than half of all Millennials already shop for healthcare services online, and increasingly, people of all ages are demanding a more consumer-friendly approach to healthcare.

We see mandates for cost transparency as an opportunity to instill greater trust across the healthcare system itself and improve the consumer experience. For example, issues with billing and payment issues among the primary drivers of patient dissatisfaction. Transparency means more accurately estimating and collecting patient responsibility pre-service and at the point of care. This up-front price transparency can help foster an improved patient/provider relationship and reduce financial risk for both.

As an industry, we’d benefit from following the lead of major online retailers and airlines by adopting a digital approach characterized by a high degree of personalization and price transparency. Providers have already captured a significant amount of data about their consumers in their EMR, ADT, and other systems. This data can be used to create the meaningful, personalized engagement and experiences that consumers crave.

Personalization plays a key role in price transparency, which to have real value must reflect an insurer’s contracted rates as well as each patient’s benefits and claims data. That pricing information must be easy to access and understand. Additionally, by making it actionable – for example, enabling consumers to purchase shoppable services much like they would interact with any digital retailer – providers empower patients to choose their physicians, procedures, and plans for care expenses that were previously a mystery until post-procedure.

Healthy Outlook

Yes, price transparency may become government-mandated. But as an industry, the goal should be to have systems in place that enable us to provide the information patients need to make the best care decisions, regardless of whether it’s required.

Let’s improve the patient’s financial experience and the quality of their overall patient journey. Not only does that help improve a patient’s ability budget for care more effectively, it helps our industry build — and maintain — patient trust.

Products: Experience Cloud

Topics: Digital Transformation, Personalization, Healthcare