ZeaMed, for years, has been exchanging ideas on healthcare education and price transparency. Price transparency and bringing prices close to consumers remains our primary goal. We feel pride in educating our readers in every possible way with unique information. This time we are digging deeper into the stakeholder roles in bringing total transparency to healthcare prices. ZeaMed has become a name for itself in healthcare price transparency.
To understand the Price transparency ecosystem, ZeaMed has done plenty of research. We have analyzed the significant role of stakeholders in transforming the US Healthcare Landscape. Let us delve deeper into what stakeholders say and perform in this arena.
The US healthcare system is complex, with hidden prices of healthcare services. However, with the three mandates passed by the Centers for Medicare & Medicaid Services (CMS), Price transparency in healthcare now seems a possible reality.
Dr Chandra Bondugula, our founder and CEO has discussed the following three mandates:
in the previous article- Hospital Price Transparency – Guide To Compliance Requirements this newsletter.
This blog further focuses on transparency’s impact on various healthcare stakeholders and how each stakeholder can play a role in making complete healthcare price transparency a reality.
Hospitals or care providers have the most significant role in making healthcare price transparency a reality. The Hospital Price Transparency mandate requires the disclosure of their pricing information publicly. They can:
- Empower patients with pricing information to make cost-conscious care decisions.
- Attract more patients with open prices.
- Avoid patients ending up in ER due to lack of access to care from hidden prices.
- See how insurance companies have negotiated with nearby providers and renegotiated contracts with better rates.
- Know how hospitals have negotiated with different insurers and negotiated better prices.
- Have to meet the CMS Transparency in Coverage mandate requirements
- Provide better estimator tools to covered people.
- Incentivize consumers to shop for services from low-cost, higher-value providers
- There is a risk of losing High Deductible Health Plan (HDHP) members as they may avoid insurance and pay cash.
- Employers are looking for direct contracting, so they may avoid insurance as third-party negotiators.
With healthcare price transparency, employers can:
- Make direct contracts with providers and avoid third-party agents.
- Ask providers to bid for employer-sponsored services.
- Incentivize employees to choose low-cost providers.
- Employers can take complete control of healthcare spending and bring them in-house.
With transparent prices in their hands, consumers can:
- Visit hospital & aggregator sites for shopping.
- Use estimator tools to know their portion of the payment.
- Use the low-cost provider services.
- May avoid insurance & pay via cash.
- Participate in the bidding of services to get the lowest price similar.
- Be proactive in seeking care and prevent themselves from becoming chronic.
- Compare Drug Pricing with other pharmaceutical companies.
- Reach out to more customers with low-cost drugs.
- Avoid PBMs and contract directly.
- Builds trust in patients.
- Compare implants between different manufacturers.
- Analyze pricing data for research studies and develop innovative solutions.
- Publish articles to educate the stakeholders.
- Develop models for payments.
- Make pricing recommendations to policymakers & advocate for fair prices.
Patient Advocacy Groups
- Empower patients through pricing education and advocate for fair prices.
- Build trust in consumers to engage with transparent providers
- Save patients money
Physicians and Healthcare Professionals
- Know how hospitals have negotiated with different insurers, and negotiate better rates using the data.
- Cost-of-care conversations can happen at the point of care. Physicians can refer patients to low-cost providers and save them money.
- Help patients make better pricing decisions using data from hospital websites.
- Increase patient trust and engagement.
- More consumers will seek preventive care if they know the cost before the treatment.
- Create awareness among Americans about transparent hospital prices.
- Bring prices to mainstream media
- Host talk shows.
- Put pressure on providers to provide transparent prices.
- Check if hospitals are meeting price transparency compliance.
- Making sure hospitals are helping consumers with pricing Information.
- Create policies about payments.
- Penalize non-compliant hospitals.
IT & Startups
- Develop consumer-friendly tools.
- Help hospitals and insurance companies become compliant.
- Bring competition among providers and insurance companies.
- Save costs to consumers and employers.
- Increase access to services.
- Drive consumerism in the healthcare market.
Value-Based Care Providers
- Can negotiate better rates with providers due to transparent rates.
- Choose providers who offer low-cost and high-quality care.
In the future, we may see more use cases in addition to the ones described above. Every stakeholder can play their role effectively and bring the desired change Americans want. When all stakeholders participate, we can achieve complete price transparency.
We should aim to create a price transparency ecosystem where everyone can participate collaboratively to bring total price transparency to healthcare and lower costs for Americans. For example, suppose all the stakeholders work to get full transparency in the healthcare prices. In that case, Americans will have the correct information to make informed cost-conscious care decisions. ZeaMed strives to educate all the stakeholders. We, as a startup, will play a significant role in building tools to help providers become CMS-compliant and compare prices to competitors. For example, employers check prices and direct contracting with providers using https://www.zeatool.com to bring prices to consumers through https://www.zeamed.com.
All other stakeholders can use https://www.zeatool.com to impact price transparency.