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Kyruus Health joins RevSpring, creating a connected care journey from search to final payment

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In the dynamic landscape of healthcare, regulatory evolution is a constant. For health plans, this means the goal isn’t just to meet the price transparency mandates of today, but to build a resilient and scalable framework that anticipates the member expectations of tomorrow. Success in this environment requires moving beyond a compliance mindset to create user-friendly tools that provide lasting value. And, while 91% of health plan executives agree that price transparency is beneficial, over half are concerned about meeting the deadlines.

This guide will walk you through the essential strategies for not only achieving compliance but also creating a member-centric price transparency experience that lasts.

How Can You Prepare for Future Price Transparency Demands?

You can prepare for future price transparency demands by focusing on three key areas: building a dedicated cross-functional team, evaluating and scaling your technical systems, and prioritizing member education from the very beginning. This approach ensures you meet today’s requirements while building a foundation for a more complex and valuable member experience tomorrow.

Pillar 1: Establish a Permanent, Cross-Functional Team for Transparency

The most effective way to manage both current and future price transparency challenges is by establishing a dedicated, cross-functional team. This team should include stakeholders from across your organization to ensure all perspectives are considered.

Start by following these steps:

  • Gather Key Stakeholders: Bring together leaders from IT, marketing, member services, legal, and product development.
  • Ask Tough Questions: Review your internal data, systems, and processes. Discuss potential roadblocks related to data quality, system functionality, and launch plans.
  • Maintain Open Communication: Create a process for ongoing communication to address issues that could impact deadlines, member experience, or future growth.

Pillar 2: Architect Your Systems for Scalability and Future Growth

Your systems must be architected for scalability, ready to handle not just today’s list of shoppable services, but any future expansion in data complexity or member queries. If a solution isn’t built for growth, it risks creating technical debt and a confusing member experience down the road.

Ask these critical questions to evaluate your systems:

  • Can it handle complexity? Many plans use older transaction methods (like 270/271 EDI) that were designed for simple queries, not the complex benefit designs common today.
  • Is it fast enough? Solutions like mock adjudication can be slow, sometimes taking several seconds per claim. If a member needs cost estimates for 300 providers at once, this will not provide a good experience.
  • How will you test and expand? Determine how your teams can adapt, test, and change systems to ensure a seamless user experience as requirements evolve.

Pillar 3: Continuously Empower Your Teams and Educate Members

You can make price transparency easy for members to understand by focusing on clear communication and user education. The goal is to help members navigate thousands of covered services and billing codes without feeling overwhelmed.

Focus your efforts in these areas:

  • Simplify the Search: How will you help members find the right services and understand the associated codes? Ensure your search functionality is intuitive and doesn’t return irrelevant results (e.g., showing behavioral health specialists for a cardiology search).
  • Train Your Teams: Your marketing, digital, and member-facing teams must be trained on the new tools, and consistently empowered to be transparency advocates. This means equipping them with the knowledge to communicate the value of these resources at every member touchpoint, helping to build long-term member confidence and healthcare literacy.
  • Highlight the Benefits: A significant amount of work goes into creating these tools. Make sure your members know about them and can use them seamlessly to see the positive impact on their healthcare journey.

Why is a Great User Experience So Critical?

A great user experience is critical because price transparency requirements are only as effective as the tools members use to access them. According to a recent survey, nearly two-thirds (63%) of health plan executives agree on this point. Regulatory requirements will inevitably shift, but a member’s positive experience with your tools builds a foundation of trust that endures through any change. Without a user-friendly interface, the burden falls on consumers to do the heavy lifting of research and analysis, which can lead to confusion and frustration.

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