In an industry accustomed to strict rules and to adapting operations to meet laws and mandates, compliance has all too often been a siloed initiative that fails to bring together cross-functional stakeholders. For example, with interoperability mandates many organizations focused only on the technical implementation. This has resulted in countless missed opportunities to optimize compliance efforts for strategic advantage.
Today, as plans lay the groundwork for complying with price transparency mandates, there is a fresh opportunity to think about compliance more strategically—and cross-functionally.
Why Transparency Must Be a Cross-Functional Effort
While the mandate requires health plans to give members access to what a particular provider charges for items and services, it also provides a jumping-off point to improve satisfaction, trust and ultimately greater market share by helping members find, understand, and compare healthcare options in a meaningful way.
Realizing this potential, however, will require the involvement of stakeholders throughout the organization. In and around organizations, more people have been involved in price transparency than you might think, just perhaps on a smaller scale, and they can help you bring together the holistic perspective you need to maximize the opportunity greater price transparency affords.
How to Identify Stakeholders
Finding these stakeholders—beyond compliance and IT alone—could require an expedition of sorts. Ask yourself: Who works with your providers to negotiate rates or share cost information for referrals in a value-based care environment? Who works to refer or manage care and referrals for your chronic population?
Keep in mind that it’s not roles or titles, per se—it’s the work being done. Consider the following areas within your organization:
- Digital or member experience—anyone who has been involved in designing digital experiences with the goal of creating a seamless experience for members, whether it be an mobile app, wellness program or access telehealth.
- Care management—after all, price transparency goes beyond member self-service to also impact coordinated care .
- Member support—folks providing phone or chat-based support today will need to provide phone and print support through the mandate, but they may also have needs for specific use cases around how they help members.
- Provider network—some organizations have provider-facing costs today, presenting a great opportunity for alignment of data, or just driving awareness of price transparency through providers at the point of care.
- Marketing/member communications—chances are, there is someone who has been responsible for communicating all of your resources to members, including price transparency capabilities to date.
- Innovation—the job of this team is to rise above what is and move the organization to what’s next. This could be use cases like voice-apps through Alexa or other tools, as well as broader strategic initiatives. Stakeholders from this area should be an integral part of maximizing the strategic value of your price transparency investments.
Together, you can build a team that moves beyond check-the-box compliance to think about how your organization does things differently—and in doing so, turn price transparency into something that differentiates you from the competition.
