While numerous studies have discussed the detrimental impact of high healthcare costs – to patient access, experience, and outcomes – policy and technological innovation have done little to combat the problem. What’s needed is a robust, interoperable network of payers, pharmacy benefit managers (PBMs), electronic health record (EHR) vendors, and health systems to work together to aggregate meaningful patient data, and deliver it when and where it matters most. By integrating reliable cost and coverage data into decision-making workflows, we can reduce the overall cost of care while improving adherence and outcomes.
Today, more Americans are covered by insurance than ever before, but many are on high-deductible plans that require thousands of dollars of patient-pay before insurance kicks in. Further, the cost of care has increased at levels faster than the rate of wage increases, meaning that patients are having to choose between managing their health or meeting their basic needs. Research shows that increased costs drive detrimental behaviors, including limited adherence to care plans or skipped care altogether. The causes a cyclical pattern of worse health outcomes for those who need care the most.
By looking at consumer behaviors from other markets, we know that choice enables better awareness of options, competition between offerings, and consumer satisfaction. But choice in healthcare is often limited by opaque systems or frequently-changing plan designs. No patient or provider can decipher the vast data to understand the cost of a specific service at a specific moment in time, and subsequently make an educated choice.
In addition to supporting policy that enables better interoperability and price transparency, we must build the infrastructure to deliver accurate data to the point-of-care so that providers and patients can have meaningful discussions around covered options, affordability, and care planning. By delivering real-time, patient-specific data from health plans and PBMs directly to care workflows, we can create a system in which selecting covered, affordable care options is the norm.
Fortunately, the transition to real-time, informed decision-making has taken hold in the pharmacy space. Real-Time Prescription Benefit (RTPB) has been a mandated capability for EHRs and Medicare Part D plans, providing significant tailwinds for the broader price transparency movement. RTPB is helping providers find low-cost (even no-cost) medication options for their patients, while avoiding prior authorization and selecting more convenient fulfillment options (mail-order, retail, etc).
But RTPB is just the beginning. Pressure is growing because of consumer demand and legislation, reinforcing the need for complete transparency around patient costs and coverage. Patient specific information – including gaps in care alerts, specialist and lab costs, pharmacy and medical benefit details, and prior authorization requirements – can all play a role in getting patients on lower-cost, covered care options that they can adhere to.
As an industry, we must come together and build the network to make this level of transparency a reality – allowing choice when it comes to patient care. Arrive Health, who partners with leading health plans, PBMs, EHR vendors, and health systems, is leading the charge in lowering healthcare costs, creating more efficient ordering processes, and driving better health outcomes. Their latest whitepaper, developed in collaboration with Fierce Healthcare, dives deeper into the challenge of improving access to affordable care, and features perspectives from distinguished industry experts. Download the whitepaper today.
To learn more about joining the industry’s fastest-growing cost and coverage network, please visit ArriveHealth.com.