As price transparency mandates continue to expand visibility into healthcare pricing from providers and insurance plans, most of the focus has been on how greater rate transparency benefits patients and consumers.  However, price transparency in healthcare can also benefit payers.

Beyond merely satisfying regulatory mandates, price transparency tools offer a strategic advantage that can drive growth, optimize networks, and reduce costs through helping leaders make more informed decisions and develop strategies to attract and retain members and optimize networks.

How price transparency tools can enhance member satisfaction and retention 

For decades, the opacity and complexity of healthcare rates kept patients in the dark, often leading to unexpected expenses, frustration, and difficult financial decisions. Some simple tools can give members accurate and instant insights into costs, helping them plan their care with their budgets in mind. 

• Member portals – Member portals are an essential component of a successful price transparency strategy. These portals generally provide a comprehensive view of in-network providers, available treatment options, and associated costs. By offering a transparent and easily navigable interface, health plans can significantly enhance the overall member experience though reducing confusion and anxiety about healthcare costs. When members trust their health plan to provide accurate and reliable cost information, they are more likely to remain loyal and engaged. This trust translates into higher satisfaction levels and improved retention rates, which are crucial for long-term success.  

• Cost estimation tools – While the No Surprises Act requires health plans to offer a price comparison tool to calculate and compare costs for particular services across different providers, cost estimation tools are essential for helping members make informed decisions about their healthcare. By integrating these tools into user-friendly online portals, health plans can ensure that members can easily access the information they need when they need it.  

Access to pricing information is critical to support member satisfaction. Members who trust their health plan to provide reliable cost information are more likely to re–enroll. Encouraging members to stay with a plan can have significant financial benefits: one study found that care systems that retained patients boosted revenue by nearly 20 percent. 

Providing accurate information online can also ease the administrative and customer service burden on payers by reducing the number of phone calls and inquiries on other channels they receive seeking pricing information.

One study found that Americans cumulatively spend an average of 12 million hours a week talking to their insurer—some of which could be prevented with more accessible information on costs. These savings could potentially be passed onto members, keeping rates lower. 

Reducing healthcare costs with price transparency tools 

In addition to enhancing member satisfaction, price transparency tools can play a crucial role in reducing healthcare costs for both members and health plans. By using advanced tools like predictive analytics and utilization management systems, health plans can proactively manage costs and improve care outcomes. 

• Predictive analytics – Predictive analytics is a powerful tool that can help health plans identify high-cost members and potential high-cost claims before they occur. For example, if predictive analytics reveal that certain members are at high risk for chronic conditions, health plans can intervene early with tailored wellness programs or early screenings. This proactive approach helps manage and potentially reduce the overall costs associated with treating advanced stages of disease, benefiting both the health plan and its members.

• Utilization management systems – Utilization management systems are another critical tool for managing healthcare costs. These systems ensure that members receive the appropriate care at the right time, avoiding unnecessary tests or procedures that can drive up costs. When integrated with price transparency tools, utilization management systems can show members and providers the cost implications of different treatment options. 

By making the cost of care more transparent, health plans can encourage providers and members to choose more cost-effective care pathways. This not only helps to reduce costs but also ensures that members receive high-quality, efficient care.  

Network optimization

Another key area where price transparency tools can drive success is in network optimization. By using –network optimization software and provider performance dashboards, health plans can build and maintain networks of high-performing, cost-effective providers.  

Ensuring that healthcare providers, services, and fees align with quality expectations and member needs while concurrently managing costs is essential for health plans’ growth and ongoing success. Price transparency data can help them nimbly balance these two objectives.

• Network optimization software – Network optimization software allows health plans to organize and analyze complex and diverse data on provider performance, costs, and quality metrics. With more visibility into pricing, health plans have more accurate information to call on when building and maintaining a network of providers offering high-quality, cost-effective care. This helps to control costs –and improvethe quality of care that members receive. When members have access to a network of high-performing providers, they are more likely to have positive healthcare experiences, leading to higher levels of satisfaction and retention. This also can give payers an edge in designing networks for new markets when they choose high-performing providers with more competitive pricing.
   

• Provider performance dashboards – Provider performance dashboards are another valuable tool for optimizing networks. They can link cost and quality data, providing payers with a more granular view into opportunities to improve care quality and efficiency. Health plans can use these insights to incentivize providers to adopt best practices that reduce costs and improve outcomes. This information can also give payers the confidence to negotiate the best possible rates with providers. 

Boosting competitive advantage 

Finally, price transparency tools can give health plans a significant competitive advantage in the marketplace. By offering tools that allow members to easily compare costs and quality across providers, health plans can differentiate themselves from competitors and attract more members. 

• Consumer transparency tools – Consumer transparency tools are essential for providing members with the information they need to make informed healthcare decisions. These tools can help aggregate pricing information across providers, enabling consumers to compare costs and choose the provider or health plan that meets their needs. Almost half of the consumers in a McKinsey survey said they researched in-network costs while considering health plans, suggesting that they are more likely to choose plans that offer clear, easily accessible information about their options.  

Tactics for promoting price transparency tools 

It’s not enough to simply put tools online that  provide access to pricing information . Members need to know how to -find , their benefits and features, anduse them effectively. This is particularly important for those who may not be as digitally savvy. 

Newsletters, email blasts, social media channels, –and notices on bills with  an explanation of benefits EOBs are a few ways to remind members that these tools are available. . Online tutorials, illustrated step-by-step explainers, webinars, and customer support can help encourage members to take advantage of this readily available information.  

Payers should also continuously monitor how members and providers are using price transparency tools. Usage data can point to potential adjustments and valuable information about user behavior that can be acted on to make tools even more useful.  

Health plans should also actively solicit member feedback to gather ideas for improvement and suggested features or functionalities. 

Reaping the benefits of price transparency   

By strategically utilizing price transparency tools, health plans can go beyond compliance to drive significant success. These tools can enhance member satisfaction, reduce healthcare costs, optimize provider networks, and give health plans a competitive edge.  

Ultimately, price transparency is about meeting regulatory requirements and creating a more efficient, transparent, and member-focused healthcare system that drives long-term success.