Lew Parker, MSIS, MBA is SVP of Engineering and CTO of Arrive Health.
The price transparency movement in healthcare is growing, supported by factors including consumer demand and rules from CMS requiring health plans and hospitals to post pricing information for covered items and services.
It’s good that organizations are complying with these regulations by uploading detailed machine-readable documents to their websites. However, it will only be great when this overwhelming amount of information is digested, personalized, and presented in a way that enables decision-making for all parties involved, at the right time.
These moments include when providers are engaging with patients and making care decisions, when care team members are helping patients manage affordability barriers, and when patients are trying to find lower-cost care options.
How do we get to this future state, when data drives behavior change in a way that impacts affordability, accessibility, and outcomes? Here are three things that must happen to make price transparency data useful.
- Translate the data. The US healthcare system is highly complex, and multiple data sources are used when completing a medication order: electronic health records (EHRs), drug databases (First Databank, Medispan, etc.), and insurance plan design and patient accumulators (plans, PBMs, and payers). There are rarely consistent fields, and even standards such as those provided by NCPDP may not go far enough to create a seamless prescribing experience. This is why the first step to price transparency must be translation. Arrive Health’s Real-Time Prescription Benefit (RTPB) solution is a good example. It makes EHR medication orders digestible for PBM/Payer claims systems, returning real-time cost and coverage information from those systems, which is easily understood by providers at the point of care – all in a matter of seconds.
- Make it simple. New tools must be simple and integrated into existing workflows if they are going to be adopted, especially considering growing provider burnout worries. Neither consumers nor providers are accustomed to pharmacy benefit jargon. Real-time cost and coverage tools must go beyond unifying and normalizing content from disparate sources by translating that information into messages that are meaningful to the appropriate audience. For example, providers, care teams, and patients all want to see different pricing information. The provider may want to see lower-cost clinically equivalent alternatives, the care team considers options that avoid a prior authorization (PA), and the patient wants to know how much they will owe at the pharmacy counter. Price transparency solutions need to account for this and deliver useful and actionable information to each individual.
- Build insights. Price transparency data will become its most powerful the more it is understood. Analytics tools can identify where opportunities exist to maximize price transparency data in clinical decision-making. Robust reporting and user-friendly dashboards show which providers are engaging the most (or least) with cost and coverage data and which are ultimately making decisions — like switching to a lower-cost medication or selecting a clinically relevant option that doesn’t require prior authorization — based on that data. Insights can also highlight which medication classes have available competitive options, and where there are barriers to medication switches.
Achieving price transparency in healthcare is challenging but possible. With all types of costs increasing, not just healthcare costs, now is the time to go beyond the bare minimum and invest in tools that will make price transparency data usable and impactful for all stakeholders involved.