Many health insurers are partnering with providers and transparency companies like Castlight, HealthSparq, and Vitals to deliver on consumer (and government) demands to be more open about the cost of care. If you’re among the payers and providers working to tackle transparency, rest assured that your efforts are worthwhile – as the health insurance landscape flattens, those who do transparency well will stand out from the pack.
Here are three insights that may help inform your approach:
Transparency is more than just costs – it also means providing information that can be easily understood. Even as “Health Insurance 101” classes, videos and other resources gain popularity, consumers are still confused by common coverage terms: out-of-pocket maximum, coinsurance, and deductible. How can consumers be expected to use their insurance effectively if they don’t understand the insurance lingo?
Educate consumers with a simple pre-boarding process so that they know what to expect from your health plan, and facilitate an engaging onboarding process to help these new and renewing members effectively use their coverage.
Transparency also refers to the need for context. Don’t just tell me the cost for a physical therapy session at a given facility. Also tell me:
- It will cost $200 to cover the 10 physical therapy sessions recommended by my doctor, including the $50 remaining on my deductible for the year.
- This facility I selected has an average 4.4 out of 5 star patient rating. Show me patient reviews, and a list of recommended physical therapists and their patient ratings.
- An office with an average 4.9 star rating is 5 minutes closer to home and will cost $250, $50 more than the facility above. Provide a link and help me switch.
- Directions from my home (and work, if I am insured through my employer).
- Information on what to expect with physical therapy, average recovery time, and other options available – for example, if other patients had good results using a chiropractor.
Provide members with context around the cost of care, directly addressing topics like deductibles and coinsurance. Leveraging high-level data about patients with similar conditions, present other options that the member may want to consider. Keep in mind that health insurers should be part of the healthcare delivery model – not just the financier.
Transparency means advising on how to use insurance when the need arises. Members want guidance on using their insurance more cost-effectively. This is different from onboarding…sort of. Keep in mind that member orientation is an ongoing process. Someone considering elective surgery or with a baby on the way will likely require some guidance on how best to utilize their insurance coverage for those life events.
Develop a member engagement strategy to address common medical situations, prioritized by scenarios where the most waste is occurring, i.e. emergency rooms vs. urgent care facilities. A PPO member might schedule an appointment with a specialist without seeing a general doctor. They may be self-diagnosing, resulting in an unnecessary and pricey medical service.
Cost, context, and advice – have you provided these for your members lately?