Support Affordability by Connecting Consumer Choice to Clinical Decision-Making


Support Affordability by Connecting Consumer Choice to Clinical Decision-Making

As seen on Modern Healthcare

Achieving price transparency in healthcare feels more important than ever, with cost often cited as a major factor in compliance and access to care. In fact, recent findings reported that 46% of people have skipped or delayed care because of cost. The downstream impact of those decisions can have critical implications not only for patient health, but also for healthcare spend, especially for those managing chronic conditions.

Although the U.S. healthcare system is meant to deliver quality patient care, the decentralized systems and processes utilized to pay for and deliver that care have created an unnecessarily complicated environment in which patients and the providers caring for them are left in the dark about how much things will cost. The result? A frustrating and alarming cycle of worse health outcomes – one that includes providers recommending care patients cannot afford, and patients choosing to skip or delay care because they have other basic needs to meet.

The state of price transparency today

On a positive note, recent policies have put the building blocks of transparency into place. The price transparency rules from the Centers for Medicare and Medicaid Services (CMS) that went into effect earlier this year mandated that insurers post pricing information for covered items and services. Hospitals were obligated to do the same starting in 2021. These regulations are focused on creating a system where patients have clarity around the cost of care, while simultaneously driving down pricing and helping patients “shop around” for the best options.

Yet obstacles remain in achieving widespread transparency, affordability and accessibility. Information overload is one of the most significant challenges for the industry to address. It is impractical to expect a human to comb through, comprehend and act on the sheer amount of information insurers and hospitals are sharing. Further, data is not often presented in usable formats or locations where providers and patients can make the most effective – and personalized – care decisions. This siloed, convoluted system perpetuates the feeling of frustration and burden that patients and providers often face when making care decisions.

Moving from information sharing to shared decision-making

Price transparency will only be valuable to patients when it leads to lower-cost decisions, and accomplishing this requires a change in how our system responds to price transparency demands. It’s no longer enough to simply make information available; organizations must ensure that information is available and usable when it matters most — at the point when providers and patients are making decisions about their care. When dealing with the massive amounts of cost and coverage data we’re talking about, this cannot be achieved without the use of technology.

The good news is that conditions are right for lasting change, and as an industry, healthcare needs to take advantage. Three key dynamics are at play that have created this opportunity:

  1. Patient out-of-pocket costs continue to rise, driving consumer demand for more information – particularly cost information.
  2. Consumer expectations for digital experiences are continuing to increase.
  3. There are significant legislative tailwinds, primarily driven by the 21st Century Cures Act and rules around information blocking.

The time is right to make data actionable with technology. With real-time connectivity, information can be transmitted within seconds from various payer systems to provider workflows and patient mobile devices. And with digital tools becoming more widely accepted, we are well-positioned to move into the next phase of patient-centered healthcare.

How do we move forward as an industry?

Healthcare’s stakeholders have been working in silos for decades, forcing the burden of finding lower-cost options onto the patient. Now is the time to create a better way – one that involves collaboration to enable providers and patients to get accurate, real-time information about costs. Only when this happens will our system be truly patient-centric, illuminating the fact that patients have care options and choices.

Arrive Health is focused on this mission, bringing together a nationwide network of EHRs, providers, health plans and pharmacy benefit managers who deliver accurate, real-time cost information when and where it matters most. It’s the real stories – like empowering a provider to identify a $0 option for a parent who couldn’t afford her child’s original prescription – that inspire us to work on behalf of patients.

The industry can create more of these moments by working together. We hope you will join us on our mission to simplify healthcare, driving access to the most affordable care for every patient nationwide.

About Kyle Kiser

Kyle Kiser is the CEO of Arrive Health, a company working to improve the value of healthcare through more informed decision-making.

Related content

Green Box
Green Box
Green Box
Click to access the login or register cheese