Leverage Price Transparency to Improve Member Experience
By Scot Alexander, Doris Lin and Mike Looney
Recent healthcare price transparency rules are part of a market-wide movement aimed at providing consumers with more visibility into the price of healthcare services, enabling members to understand and compare costs of treatment ahead of time, and empowering people to make informed decisions about their care.
These federal regulations are complex and may require considerable technology investments, including but not limited to developing or improving online tools that provide pricing and cost-sharing information for health services. As a result, healthcare entities may be inclined to address the bare minimum to avoid high expense and disruption of their day-to-day operations.
At Optimity, we see price transparency mandates as an opportunity for healthcare payers to deliver a better experience that delights members, exceeds their expectations, and builds trust across their healthcare experience. Members who feel empowered by simple pricing awareness are likely to pursue better outcomes and have higher loyalty because of their perception of plan value, leading to easier member acquisition and better retention.
Members demand a consumer-centric experience
We are in the age of consumerism in healthcare. Members no longer simply rely on payers and providers to manage their benefits and care — they are savvy consumers and, with the rise of healthcare costs, want to be in control of their own healthcare decisions. Technology also has enabled access to information and self-service at the member’s fingertips, further driving a consumer mindset. Consumers want to shop around for health plans and doctors the same way they do for other products, and increasingly expect their experiences to be no different from other industries like retail, travel or banking.
But price transparency means much more than simply posting a menu of prices — just because a payer publishes cost information online doesn’t mean members know it’s there or know how to use it. To meet consumer demands and expectations, healthcare payers must consider where this information is delivered to members, so it is easy to use (such as on their mobile devices), how information is presented so it is understandable and relevant to their needs, and when information is provided in order to meet members where they are in their healthcare journey.
Price transparency is just part of the member advocacy picture
Providing pricing and cost-sharing information focuses on value, which is one facet of the full shopping experience. When we shop for any product or service, we consider price but also quality and convenience. Likewise, when making healthcare decisions, members don’t just consider cost but also other factors such as provider experience, quality rating, specialty, location, and hospital affiliations. Moreover, it is critical that members have accurate out-of-pocket cost calculations that include all costs related to a health event, so they can see the big picture and have a truly “no surprise billing” experience (building trust and increasing loyalty).
Payers are in the unique position to offer this big picture, with access to provider and member plan data. Consider how payers can support their members throughout all facets of their research and decision-making process, so the member feels confident in selecting the best value and quality of care, resulting in higher satisfaction and better health outcomes in the long term.
Go beyond the mandate – Turn it into your competitive advantage
Healthcare is a high-touchpoint industry, which means customer experience is critical to member satisfaction and will only increase in importance over time. While complying with the price transparency mandates will satisfy the law, incorporating them into your member engagement strategy and digital roadmap is an opportunity to deliver a seamless and unforgettable experience that will give you an edge over your competition. For example, plans that created bundled payments exceeded consumer demands and gained a strategic advantage in the market.
Bottom line: Health plan members are savvy consumers demanding visibility and control over their care decisions. Providing transparent healthcare cost information in an intuitive, friendly, engaging way will help members become more educated about their healthcare options, leading to a better overall healthcare experience. Member satisfaction builds trust, which in turn cultivates loyalty.
Apply design thinking to build a consumer-centric member experience
To incorporate price transparency into the member experience in a meaningful way, payers should start by examining the healthcare cost journey through the lens of their members. The design thinking methodology, a human-centered approach to innovation, uses tools such as personas and journey mapping to build empathy to anticipate member needs and preferences. Design thinking reveals opportunities and gaps in members’ healthcare journey and provides a structured process to create a seamless digital journey and ideate on solutions to help members understand healthcare pricing at their moment of need and access the best tool to empower their care decisions.
In our Orange Paper “Price Transparency through the Lens of a Member,” we share our approach on how payers can map the member healthcare journey to develop the strategy and vision for a seamless member experience and to innovate on digital capabilities that effectively support members in their healthcare decision-making process.