How real-time benefit transparency is helping payers, providers and care managers

In recent years, consumers’ sentiments around their health plans have shifted dramatically: people are increasingly worried about the soaring costs of health care and their financial obligations within their health plans, while in tandem expecting premium experiences with streamlined integrations that allow them to seamlessly navigate, make smart decisions, and actively participate in their own care management. We have seen many industries shift to a more personalized, digital business approach to engaging consumers, which some are deeming an effort to replicate the ‘Amazon experience,’ in which services are integrated and personalized to suit an individual’s needs. The health care industry is no exception.

Real-time benefit transparency is transforming the health care industry by meeting the growing demand for informed decision-making and improved patient outcomes. By providing critical information at the point of care, real-time benefit transparency empowers payers, providers, and care managers to optimize health plans and ensure members get the most out of their coverage. For consumers, real-time benefit transparency allows for more control, transparency, and affordability when it comes to managing their health care needs. The potential benefits of implementing real-time transparency and a digital experience cannot be overstated.

Empowering informed decision-making

In 2016, the 21st Century Cures Act began changing how patients receive results and interact with their health information. In an effort to increase transparency, a provision included requirements for all medical testing centers to release patients’ results “without delay.” In April 2021, the U.S. Department of Health and Human Services began enforcing a rule that prevented providers and health systems from “blocking” patients from their own health information. Over time, increasing easy and instant access to this data has encouraged consumers to play a more active role in their care.

For providers and care managers, real-time benefit transparency equips these stakeholders with instant access to patient insurance coverage information, enabling them to make informed decisions about treatment plans, medication choices, and cost-efficient alternatives. Instantaneous access to this information ensures that members receive the most appropriate and affordable care, optimizing health plan utilization and enhancing patient outcomes.

Enhancing patient understanding and engagement

Well-informed consumers are equipped to make better decisions when it comes to their health plans. Transparently sharing real-time benefit information has the ability to improve patients’ understanding of coverage details, cost-sharing responsibilities, and available health care options, empowering members to actively participate in their care management and maximize the benefits provided by their health plans. As out-of-pocket costs continue to rise, the ability to engage with and understand coverage details is a differentiator for members. As more patients embrace – and expect – these capabilities, real-time benefit transparency contributes to improved satisfaction and overall health care experiences.

Streamlining care delivery and reducing administrative costs

Perhaps the most integral benefit for providers is the ability to simplify administrative tasks. By seamlessly integrating member data into care management systems, stakeholders can efficiently navigate insurance requirements, streamline prior authorizations, and expedite the approval process. This optimization of care delivery reduces administrative costs and enables resources to be allocated more effectively, resulting in improved operational efficiency for payers, providers, and ultimately, those receiving care.

Strengthening payer-provider-care manager collaboration

Real-time benefit transparency fosters stronger collaboration between payers, providers, and care managers by facilitating seamless communication and information exchange. In turn, stakeholders can work together to optimize health plans, coordinate care effectively, and ensure members receive appropriate and timely treatments. This collaboration enhances the overall value of health care services, strengthens relationships, and supports the mutual goal of maximizing health plan benefits for members.

Supporting value-based care

Prioritizing real-time benefit transparency aligns closely with the principles of value-based care by emphasizing patient outcomes, cost-effectiveness, and quality improvement. Providers and care managers can leverage real-time benefit data to optimize treatment plans based on cost, efficacy, and patient preferences. This approach not only improves patient outcomes but also enhances the overall value and efficiency of health care delivery – the ultimate goal of value-based care initiatives.

Related: Implementing value-based health care: Key trends shaping 2023

As we prepare for continued rising health care costs and increasing consumer demands, real-time benefit transparency is transforming health care by optimizing health plans from end-to-end for payers, providers, and care managers. By providing crucial information at the point of care, real-time benefit transparency empowers stakeholders to make informed decisions, enhance patient understanding and engagement, streamline care delivery, and strengthen collaboration. As the health care landscape evolves, the adoption of real-time benefit transparency will continue to play a vital role in maximizing the benefits of health plans, improving patient outcomes, and achieving a more efficient and value-driven health care system.

Jennie Giuliany, lead clinician, client management at HealthEdge