Reflecting on 2019: The Year of Price Transparency in Healthcare

There is little doubt that 2019 marks the official beginning of the price transparency movement in healthcare. The year kicked off as the CMS hospital price transparency rule went into effect, requiring U.S. hospitals to publicize their list of standard charges online. Later in November, CMS released a proposed “Transparency in Coverage” rule, which would require health plans to disclose their negotiated rates for both in- and out-of-network providers, and to provide consumers with specific details about their cost-sharing obligations for covered healthcare services.

As with any disruption in “business as usual”, there has been pushback. The year culminated with several hospital groups and individual facilities suing CMS over the legality of these regulations. The road to price transparency may be a rocky one, but it is a critical step in creating a consumer-centric healthcare ecosystem.  

As I look back over the past year, I’d like to share some reflections and thoughts on how we can all embrace transparency to create a community of care that works for all stakeholders.

Transparency is more than simply pulling back the curtain

In January, I participated on a panel during the HFMA Revenue Cycle Conference for the Massachusetts-Rhode Island Chapter. Our discussion explored price transparency – the trends, the challenges, and the impacts on providers and patients. As we delved into the value of the patient financial experience, what really resonated with me was how integral transparency is to building trust.

The mandate for price transparency is more than just a call for providers to publish their charge lists. It is an opportunity to instill greater trust across the healthcare system. Unfortunately, there has been a significant erosion of trust in healthcare over the last several decades. 

Thomas Watson, the founder of IBM, once said “The toughest thing about the power of trust is that it’s very difficult to build and very easy to destroy.” Transparency is essential to building and maintaining trust. A breakdown of trust can hinder progress, innovation, and growth; however, fostering trust drives innovation and can improve the quality of care and health outcomes.

A dead end or a speed bump?

The purpose of a speed bump is to slow down traffic and make streets safer. A dead end is, well, a dead end – there is nowhere to go. While the road to price transparency may be bumpy, it does not have to be a dead end. Sometimes, it is just a matter of perspective.  

Over the last decade there has been enormous change in the healthcare industry, creating both opportunities for growth and challenges to overcome. Consumerism has been a major driver in this new landscape. Patients-turned-consumers want the same convenient, fast, and tailored experiences they are getting from other industries.

Healthcare organizations can approach these new demands as either speed bumps or dead ends. They can choose to leverage innovations to streamline the entire patient treatment journey, including the payment experience. Or they can do nothing and flounder.  

During a presentation at a MAPAM (Massachusetts Association of Patient Account Management) meeting in March, I took the audience on a “tour” of four hospitals in the Philadelphia / Eastern Pennsylvania region. Each hospital had taken a different approach to the new price transparency rule. One had met the minimum requirements, and two had made moderate adjustments.

The fourth had gone above and beyond by creating a price checker in addition to publishing its chargemaster on the website. This organization treated the transparency “speed bump” as an opportunity to thoughtfully create price transparency, which ultimately accelerated its competitive advantage.

Interoperability: The backbone of an effective ecosystem

CMS announced a proposed rule for interoperability and patient access in February. The intention of this rule is to create an ecosystem that improves access to information that individuals need to make informed healthcare decisions, including data about health care prices and outcomes.

One of the biggest barriers to high-quality, efficient care delivery is the ongoing presence of data silos. It is generally known that a fragmented system results in breakdowns in communication, transparency, and access – we’ve been talking about the issue for years.

Interoperability cannot just be a talking point anymore. Without it, transparency in healthcare is not possible. A Health IT solution that does not contribute to connecting ecosystems is not innovative.

So how do we achieve an effective ecosystem in a highly competitive environment? By building a community centered on the patient and aligning all the stakeholder goals toward the patients’ needs. Each stakeholder – whether a payer, health system, or Health IT company – may have slightly different goals and objectives in terms of growth and revenue, but at the end of the day, the interconnectedness will drive the delivery of what the patient needs. Much like an orchestra with each instrument playing its unique part to produce the completely harmonious sound of a symphony.

A community of care supported by integrated access to information and interoperability that facilitates patient data flow, will enable all parties to communicate and collaborate more effectively and to achieve the common goal of providing patients with the highest level of care possible.

Looking to the future

In early December, Tim Grisham, our Vice President of Customer Success, presented “Driving a Digital Transformation” at the NGPX (Next Generation Patient Experience) 2019 conference. He led a discussion on the impacts of AI and machine learning on patient experience and health outcomes. As we move into the next decade, increasingly sophisticated technologies will stimulate a rapid evolution of healthcare that focuses on outcome-based healthcare and meets the needs and demands of patients.

This new era of Health IT will bring intelligent solutions designed to close even more healthcare delivery gaps and offer a more seamless experience for all. If all stakeholders are united in a common vision, these advanced technologies have the potential to enable providers to deliver optimal, efficient care and empower consumers to be active, informed participants in every phase of their treatment journeys.