The impact of evolving transparency tools

As health and wellbeing technology continues to evolve, new solutions emerge that contribute to changing the shape of the benefits industry, including those addressing cost and quality transparency. While pricing transparency tools have been available for a number of years, recent developments across the workplace benefits environment are prompting a harder look at these offerings and driving a need for growth and expansion in the market.

Growing demand for quality information

Employers and their benefits consultants continue to pursue efforts to improve outcomes, quality, cost and the overall health care experience for employees. This effort has been further accelerated by the new pricing transparency regulations that went into effect early next year. Implementing provider cost and quality tools is now a must-have, with an emphasis on helping employees identify and seek care from high-quality providers.

This is indicative of a larger trend toward prioritizing solutions that combine quality and cost data. Standalone pricing transparency tools no longer provide enough data for employees and their families to make informed decisions about their health care. Steering them toward high-quality, high-value providers is critical to both improve outcomes and manage costs, as well as address social determinants of health by increasing access to high-quality health care services. Employees need the full spectrum of information combined with personalized support to take the next steps and get the care they need.

Impact on benefits industry

As a result of this increased demand for cost and quality information, a number of solution providers are working to meet this need by creating new resources as well as incorporating quality data into existing transparency tools. This includes expanding data access and utilization.

In addition to historic claims data, organizations are now leveraging a wide range of internal and third-party data sources to measure and analyze provider quality, including:

• Medicare claims data
• Commercial payer data
• Member surveys/patient satisfaction
• Outcomes and other clinical data
• Board certifications

The more robust the pool of information the solution utilizes, the more accurate and detailed the resulting analysis will be, ensuring users have the background necessary to select high-quality, low-cost providers that are the right fit for them.

The impact of this trend is the ongoing influx of new tools being introduced to address the existing gap in the benefits industry, which will help drive new innovations and adaptations that will benefit both organizations and their employees by increasing access to high-quality providers, reducing costs and improving health outcomes.

However, as more of these tools are introduced into the marketplace, it is critical for brokers and employers to take a close look at what makes an effective provider cost and quality tool that will provide the best value and user experience.

Must-have capabilities

While robust data sources are a key component of an effective tool, this is just one characteristic that should be considered when reviewing available options. Some questions and considerations to keep in mind:

• Depth and variety of data. Does the solution include multiple nationally-recognized third-party sources that cover both cost and quality? Is the solution built using massive and rich data sources, including a majority of U.S. lives covered by commercial and Medicare claims? What percentage of providers is reflected in the information available? Is a majority of data analyzed provided by an independent, objective source?
• User experience. Does the tool have a self-serve option that employees/members can use on their own to search for in-network, high-quality, low-cost providers that fit their needs? Is it available on multiple platforms, including mobile? Is it easy to navigate?
• Expert support. In addition to a self-service capability, is the tool integrated with expert support? Having the option to connect with an expert ensures users have someone to turn to who can answer their questions and help guide them to the most cost-effective solutions in their network. In addition to helping steer them through the search process, a trusted expert can help them narrow down their choices, move medical records, make an appointment, get preauthorization, or provide any other assistance they need in order to access these high-quality services, ensuring they get the care they need.
• Integration with other benefits. Does the tool interface with other employee health and wellbeing benefits? While the information provided in these tools is valuable on its own, users are more likely have the opportunity to access low-cost, high-quality care and take action when it is connected to other benefits programs. As an example, tools are more impactful if they integrate real-time out-of-pocket estimates based on users’ benefit plan information and remaining deductibles so they get the full picture as they select a provider.
• Compliant with health care pricing transparency regulations. Is the tool on track to be compliant with government transparency regulations, including the No Surprises Act and the upcoming Transparency in Coverage rules?

Provider cost and quality search tools provide a great deal of value for both organizations and their employees. Not only do they have the potential to reduce medical cost trend growth by guiding employees to high-quality, low-cost providers, they can also engender higher employee satisfaction since they feel employers are investing in their wellbeing. The best tools can help employees become better health care consumers by identifying high-value providers and helping them understand their out-of-pocket costs and the full costs of their care so they can make informed decisions for themselves and their family members.

The evolution of these tools is raising the bar across the industry, pressing solution providers to create more innovative offerings, supported by leading-edge technology and data analytics, that can help steer employees towards high-quality, cost-effective providers in their network. While pricing transparency tools laid the foundation for today’s technology, the increased emphasis on incorporating quality data is taking these tools to the next level.

Marcia Otto is Vice President, Product Strategy at Health Advocate.