As the industry stares down unsustainable price increases and member dissatisfaction with care quality, it’s clear that new approaches to healthcare decision making are needed to protect patients, plans and payers from the challenges of operating within an opaque and complicated system.
Comprehensive price and quality transparency tools offer a much-needed solution.
By enhancing visibility during the care selection process, transparency tools are extremely effective at guiding smarter member decisions, ultimately supporting better care outcomes and reduced healthcare costs for all.
The Visibility Gap: Why Healthcare Still Lacks True Transparency
Despite regulatory efforts and transparency mandates from the U.S. government, price and care outcomes data within the healthcare industry is still highly fragmented — deeply siloed across organizations and often difficult to interpret, especially for plan members with low healthcare literacy.
Research shows that as few as 10% of plan members are currently using these tools. Confusion and lack of visibility play a key role; even when presented with pricing data, the onus is on members to interpret and act upon that information efficiently, yet another task for already frustrated healthcare consumers.
For those who do use these tools, estimated pricing data is often decoupled from care quality outcomes data. As a result, many members make healthcare decisions without understanding the full picture of variation not just in price but also in provider quality — a costly mistake when higher care prices don’t necessarily equal higher-quality care.
Add in the prevailing fee-for-service approach to healthcare — “more is better” — and today’s healthcare consumers are primed to make decisions that are not only expensive but also contribute to long-term health consequences.
For example, plan members who rely on “check-the-box" price transparency tools from their health plans may inadvertently be guided to lower-quality providers and facilities based on cost alone, decisions which can result in complications and higher healthcare costs down the line for employees, employers and plans.
Fortunately, these risks are avoidable — and the answer lies in a more comprehensive, value-based approach to transparency.
A Value-Based, Cost-Effective Approach: Price and Quality Transparency
To guide smarter member decisions that not only reduce costs but also ensure high-quality care delivery, health plan designers must go a step further with their transparency strategy by offering tools that combine both price and quality comparisons for a fuller picture of the care options available to members.
With the integration of care quality indicators, members are empowered to make smarter decisions before they ever step foot into a doctor’s office. And, as part of a proactive approach to both cost containment and quality control, these transparency tools support a culture of “shopping” for healthcare, ultimately creating a positive feedback loop of lower costs and better care outcomes as more members engage with these platforms.
The best transparency tools don’t just include price and quality information; they also actively educate and guide members to select higher-quality providers through visuals and incentives. As just one example, the Valenz Bluebook platform uses a “green-yellow-red" rating system to highlight providers that offer higher-quality care at the lowest price, making it easy for members to identify the best options for their needs.
It’s also critical that the price and quality data within transparency tools be thorough and objective. Many providers and facilities use self-reported data to promote their care quality scores; transparency tools fed by a variety of unbiased, risk-adjusted data sources provide a more accurate picture of provider performance and cost estimates for consumers.
With this valuable data in hand, health plan members become an active participant in their personal care journeys — selecting providers and facilities that they can trust to provide high-quality care at a lower cost, supporting the advancement of a value-based model that’s the future of the American healthcare system.
Data Transparency as a Practical Path to Lower Cost by Improving Care Outcomes
In the face of rising healthcare prices, cost control doesn’t have to mean reducing access to care or limiting member choices.
Instead, it can be achieved by giving patients access to the information they need to make smarter, better, faster healthcare choices.
With comprehensive price and quality transparency tools, employers and plan sponsors can significantly reduce healthcare costs, improve the member experience and ensure high-quality care access by putting the power in the consumer’s hands.
Forward-thinking employers and plan designers should seek out transparency solutions that not only offer comprehensive, unbiased price and quality data but also make it easy to understand and use through ongoing education and engagement campaigns.
With the Valenz Bluebook solution, members get access to all of those benefits and more, including an average procedure savings of up to 50% each time a member uses the platform.
Discover the potential for your benefits plan strategy by contacting Vālenz Health® today.
