Readers Write: Debunking Price Transparency Myths to Enable True Progress

Debunking Price Transparency Myths to Enable True Progress
By Kyle Raffaniello

Kyle Raffaniello, MSHA is CEO of Sapphire Digital of Lyndhurst, NJ.

For years now, the US has had the highest healthcare costs in the world. While high medical costs are nothing new, these costs, in combination with the financial impact of the COVID-19 pandemic, could turn healthcare from unaffordable to unattainable for many Americans. Now more than ever, we must kick the nation’s price transparency conversations into overdrive to increase industry competition and lower the cost of care.

Increasing price transparency in healthcare is not a new goal by any means. The term has been used for years to not much avail, but has gained headlines in recent months because the Trump administration is making it a health policy focus and has announced multiple rules aimed at increasing transparency. However, confusion and uncertainty still linger around what transparency truly means for healthcare and whether it really works.

The truth is that it’s the foundation to making healthcare more affordable for Americans. Unfortunately, several common transparency myths muddy the waters for all:

Myth #1: Transparency Doesn’t Work

Transparency not only works, it is essential to lowering healthcare prices in our country and saving money for consumers and employers. For example, a hospital in Kentucky recently heard about the success Kentucky Employee Health Plan (KEHP) was having helping members find cost-effective facilities for their care when they used digital shopping solutions. Now the hospital wants to lower its prices and be more competitive in order to keep local business, as consumers had been going to get procedures done at more cost-effective facilities. Market forces will compel high-cost facilities to lower their prices to compete.

Myth #2: Cost Equates to Quality

An age-old adage, cost equating to quality, is simply not true when it comes to healthcare. Through the use of the right digital shopping tools, consumers can compare cost options and quality to find and select low-cost facilities that have high marks on quality, equating to high-value care. It’s time we all understand that quality doesn’t need to be compromised for cost or vice versa – this isn’t an either-or scenario.

Myth #3: Industry Stakeholders Don’t Want to Support Transparency

A common misconception is that not everyone in healthcare supports transparency because it’s not in their best interest. The truth is that most industry stakeholders do support transparency — they simply have differing views on how to achieve it. We must accept that different parts of the industry have different viewpoints when it comes to strategy and focus on the ways we can come together to achieve the common goal.

A recent survey found that nearly half (47%) of Americans age 18-64 surveyed are more concerned about the cost of healthcare now than they were before COVID-19. That same percentage of people also said they plan to change how they access care as part of our “new normal.” It’s clear that consumers want to shop for care and the market wants to increase transparency. In order to align stakeholders and ignite change in healthcare, companies in the transparency space must educate consumers about the right tools, support, and information to compare care options and engage the consumer in actively shopping for that care.

When we talk about the right information, this goes well beyond publishing a list of prices for procedures online, as these lists are not true to what patients will pay out of pocket. True transparency involves digital shopping platforms that can present consumers with a look at how much they will individually owe based on their insurance provider and individual health plan. Additionally, the listing of prices does not provide insight into the quality of care at a particular hospital or medical facility.

Digital tools will include the important qualitative information consumers can’t get elsewhere to ensure they’re not only choosing low-cost care, but high-quality care as well. Offering incentives to help consumers go beyond their research and actively shop for their procedures is important, too. Some digital shopping tools offer cash rewards, as a share of the savings, for consumers who choose high-value care.

Everyone needs and deserves access to low-cost, high-quality care, and we need to work together as an industry to make that happen. Through raising awareness of these tools, more consumers will become empowered and incentivized to use them, ultimately making more informed and confident decisions about their care. Additionally, there will be healthy competition among hospitals and medical facilities in the industry, driving down costs for the entire healthcare ecosystem.

The need for robust transparency that presents an easy healthcare shopping and comparison experience for consumers has never been more important following the impacts from COVID-19. As facilities reopen and begin rescheduling appointments, we must put the pedal to the metal and bring true transparency to the healthcare industry. Transparency is no longer an option, but a necessity for the livelihood of the industry and the consumers who power it.