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For most people, January means a new health plan benefit year. But, this year is different. Now all health plan members with employer group or individual insurance can more easily plan for the cost of their healthcare. As of January 1, group health plans and health insurers are required to deliver out-of-pocket cost estimates for 500 “shoppable” items and services as a part of the Transparency in Coverage mandate and No Surprises Act legislation.

Working with leading market research consultancy Wakefield Research, HealthSparq surveyed 200 health plan executives to understand their sentiment around federal transparency requirements, challenges, and opportunities. While it is no surprise, nine in 10 executives agreed on the across-the-board benefits of transparency. The survey also showed there are concerns about delivering the experience and ensuring value to members.

The new transparency requirements are complicated  

Nearly all health plan executives (99%) recognize the difficulties in delivering price transparency to their members. While many plans already had some kind of pricing information available for members and care teams, the Transparency in Coverage mandate is different: plans must use negotiated rates to deliver out-of-pocket costs. This involves new data, new systems, and new workflows. The most difficult aspects of transparency cited by executives include:

  • Meeting enforcement deadlines (55%)
  • Updating rates data regularly (52%)
  • And, ensuring the member experience isn’t confusing (47%).

A better experience is on the horizon

Most health plan executives agreed that implementing the mandate promises a better experience for consumers, empowering their financial well-being. Regardless of associated challenges, nearly 4 in 5 (78%) say that new member-facing tools for price transparency will improve consumers’ experiences, with more than 1 in 4 (28%) saying it will improve significantly.

Readiness and value

While almost a third (30%) of insurers are focused solely on meeting the letter of the price transparency mandates, the rest are thinking strategically to leverage the January 2023 requirement to go beyond mandate basics to offer new member experiences. Given the importance of member experience for plans, this isn’t a surprise. Conversely, there are some plans that, until very recently, were still in planning mode. At the end of 2022, nearly a tenth (9%) of respondents said they were still evaluating their options to meet the member-facing requirements.

We’re working with health plans and TPAs across the country to support their compliance efforts and  deliver meaningful, guided experiences. We are already working with clients on the next mandate deadline of January 1, 2024, when health plans will be required to provide members with self-service tools to find out-of-pocket cost estimates for all covered items and services.  If you’re interested in learning more about our approach to transparency and guidance, get in touch with us today.

Our full report will be available in the coming weeks. In the meantime, read more on our transparency research with health plan executives in Managed Healthcare Executive.