Transparent goals: why the future of transparency is a shared responsibility

Although it is much easier to support transparency when someone else is doing the heavy lifting, it is only truly effective when all stakeholders share the burden. “The reality is that it’s everyone’s responsibility,” according to Dennis Charland, senior vice president of sales for Zelis.

Charland moderated “Price Transparency Collaboration,” a panel discussion during the Self-Insurance Institute of America’s (SIIA) Price Transparency Forum in late February.

“I don’t disagree with the intent of transparency,” said Kelly Wage, vice president for consumer experience and market solutions for Blue Cross Blue Shield of South Carolina. “The good news for us is that we already had a client transparency tool. However, filling all of these new files and getting it to a third-party vendor was complicated. It is kind of like Whac-A-Mole. It’s been really complex to implement.”

But despite the complexities involved, the process is going well overall, the panelists said.

“For certain payers, this hasn’t been that bad,” Wage said. “When you have a member claim, you usually get involved in it anyway. The companies I work with already have been involved in negotiating balance bill payments. Will it be more work? It will be different work, but I don’t see it as being all that bad.”

Ed Doherty, vice president of Aon’s legal consulting group in Los Angeles, works with clients with ERISA plans.

“When I talk to my clients about the process and what it means, their eyes glaze over and they say, `the TPA is handling this,’” he said. “But they are the ones ultimately responsible for publishing these files, and there is no way for my clients to possibly do that. It comes down to what is the obligation of the employer, the plan sponsor, and how do we plug those gaps?”

As it turns out, the answer is simpler than expected.

“We got guidance from regulators after the fact that they really didn’t intend for employees to create a public website and narrowed down the circumstances in which an employer would actually have to do anything,” he said. “There was a lot of worry last year that turned out to be not that big of a deal from our employers’ perspective.”

Chris Moyer, vice president of Health Now Administrative Services, looks at the challenges through the lens of a third-party administrator.

“Nobody can dispute what we are trying to do from a transparency perspective, but creating uniformity is key,” he said. “What if I have six clients? Everyone wants it to be uniform, but no one can get to that uniform state. TPAs have a lot on their plate, because they are serving multiple masters. They are serving not only their clients but also  the consultant who says, `my client can’t do this – you need to get this done for my client.’” 

Although each stakeholder faces different challenges, they share the objective of taking care of their clients’ needs.

“At the end of the day, the client is ultimately responsible,” Moyer said. “They can’t do this without all of us working together. That’s really the key. If you have 10 different relationships and nine are working fine but one has not quite figured it out yet, technically you are not complying.

“There is no one entity that can supply all of the information. There is no way a self-funded employer could get access to that information. We are all doing the best we possibly can to pull our piece of it together.”