The calendar flipping over to 2021 not only marked the start of a new year but also marked two new healthcare transparency rules going into effect.
As healthcare costs continue to rise, The Centers for Medicare & Medicaid Services (CMS) projects healthcare spending to consume almost 20% of the economy by 2027. Economists argue that transparency will allow patients to make informed decisions about how they spend their healthcare dollars; patients, facing increasing copays and out of pocket costs, agree.
So what does cost transparency really mean in light of the new rules? How can healthcare organizations prepare to brave these new rules? Finally, most importantly, what will this mean to patients? Let’s decode the new rules and their impact on providers and patients.
Compliance with the new transparency rules will require provider and payor organizations alike to think through and track data from procedures to service packages to payments. Nerdery has worked with some of our nation’s largest health systems and with Fortune 500 companies mapping data ecosystems and developing data strategies.
Through contextual inquiry and user ethnography, Nerdery can help your organization understand the way patients and beneficiaries think about medical procedures, connecting the dots between search terms and concepts, and partner with you to create useful, usable online price-estimation and cost-sharing tools, designed to capture and clearly communicate brand value.
The U.S. government considers price transparency key to containing rising healthcare costs by giving patients the ability to shop for care, avoid surprise costs, and spur competition in the market.
The new transparency rules are likely to bring about a real shift in the ways consumers leverage information in making care choices. The ability to understand customer segments and how their use of cost information differs will create competitive advantages. Organizations that invest now in solid data strategies and ecosystems and carefully designed digital tools will be a step ahead.
While cost transparency will bring a much needed relief to patients to help make informed decisions about their healthcare costs, there is much more to be seen and understood. How comfortable will patients be in assessing the costs? How will it impact the decisions they make in seeking more affordable care? How will this impact different stratas of society? Will this demystify or further expose the loopholes in the US healthcare system? Or will it truly be a starting point for democratization of healthcare? Nerdery teams will continue to monitor this change and keep you informed.
New provider transparency ruling in Federal Register: CY 2020 Hospital Outpatient PPS Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates. Price Transparency Requirements for Hospitals To Make Standard Charges Public
New payor transparency ruling in the Federal Register: Transparency in Coverage