Consumers ask the basic question- “How much does this cost?”-For most purchases. But for healthcare, which spends nearly $ 4 trillion, it’s a question that’s almost impossible to answer.
For decades, consumers have navigated the entire range of cost and quality initiatives, from promoting managed care in the 1990s to deploying star majors and online cost calculators. But what was particularly lacking in all of these efforts was true transparency regarding the actual price of consumer medical services.
This black box around healthcare pricing is so pervasive that even the most savvy consumers of healthcare are surprised by unexpected billing and billing. Policy makers have dealt with the worst medical surprises: unexpected, exorbitant out-of-network claims, No surprise method, Consumers still bear the special costs of our opaque healthcare system.
Profit design, for better or for worse, brings a significant proportion of consumer confusion. At any time, patients coordinate deductible, joint insurance, out-of-pocket caps, and myriad different rates between primary and specialty care, and hospital visits to measure what the final claim is. The fact that you need to be reluctant to do smart shopping in the first place. Highly deductible policies transfer much of this unknown cost burden to consumers.
Hospital transparency rules, health insurance price transparency rules, and No surprise method, May reduce the inherent frustration and confusion that comes from healthcare shopping. However, the system is still not oriented to serve the best interests and health of the patient, and these rules have daily when consumers navigate invoices after receiving care. It does not rule out surprises. You need to change that.
Accountable Care and the New “Medical Home”
Responsible care providers may be in a good position to bridge the gap between patient care and their understanding of medical costs. Health care providers and health plans engaged in responsible care recognize that patient involvement requires a constant feedback loop. In this loop, the care team is familiar with not only the health needs of consumers, but also the design of benefits and other factors that influence the decision to seek health care.
One way to think about this is as a “new medical facility”, an extension of the concept that helped transform advanced primary care. This type of engagement needs to be at the core of an accountable care strategy and serves as the basis for more responsive and successful care navigation that can reduce unfortunate medical surprises.
Some medical companies, such as Kaiser Permanente, have fully adopted digital and face-to-face support systems that proactively and intuitively address the various health and cost concerns patients may face. .. The care team can talk about coverage and benefits along with diagnosis and treatment planning so that patients can be supported in real time and ultimately make the best choices for their care. The care team also provides direct delivery of referrals and visits to specialists within each network, providing all one-click seamless prompts for patients to schedule follow-up appointments. In most cases, the estimated or actual cost of the appointment will be recorded at the time of the schedule.
Other approaches to transparency focus on providing better information to consumers before choosing care or treatment. Castlight Health, Morgan Health’s portfolio company, acts as a digital navigation platform that includes care guides and integrates into medical benefits to enable consumers to support costs and treatment options in real time before launching medical services. By providing personalized communication with employees via text, email, phone and chat, we actively connect patients with the care they need and understand costs to mitigate surprises.
All patients deserve this level of support and transparency. Morgan Health’s investment team aims to improve the medical experience of more than 150 million Americans with employer-sponsored insurance to ensure that patients are not stuck, lost or ignored. Helps advance and expand new approaches to responsible care and care navigation. – Wherever you are in the system.
Morgan Health also recognizes that responsible care has important challenges that must be overcome before this fundamental goal of employees and employers can be achieved. As a basic starting point, simplified out-of-pocket and co-insurance rationalization of benefit design clearly explains the consumer insurance turmoil. At the same time, primary care providers need access to real-time, accurate and available pricing data that can be seamlessly converted and integrated into electronic health records. Continued delays and lack of progress in providing meaningful and practical pricing data will keep patients, employees, and employers in the dark.
Greater accountability and transparency help millions of Americans transform the entire system needed to improve the quality, affordability and equity of care only when requested. increase.
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