Opening Up Price and Quality Information
When you want to buy a car, you can find pricing on the internet and in the sticker on a car. You want a haircut? The price is listed at the shop. So why can’t you find the price on health care services? It’s complicated.
Providers, patients and even health benefit plans don’t know the exact cost of services. That is because health insurance issuers and claims administrators control the repricing of services using obscure, “proprietary”, and/or dissembled pricing mechanisms. The result is: plan sponsors (i.e. employers) don’t know what the cost of care is in their plan, providers don’t exactly know what they will be paid, and patients don’t know what they have to pay.
Another new health care law included in the Consolidated Appropriations Act of 2021 is the prohibition on gag clauses on disclosing price and quality information. What this means is health plans and health insurance issuers can’t keep pricing secret anymore. This should allow patients to know the price they are going to pay and providers to know what they are going to be paid. After all, knowledge is power.
Knowing the changes in these new laws is only half the challenge. How to incorporate the changes to benefit your business is the bigger challenge. Contact me if you need expert help in getting started with making your health care business successful.