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Last month was a major milestone for the healthcare industry. From 2019 when the federal Transparency in Coverage (TiC) rules were first announced to the posting of federally mandated machine-readable files (MRFs) with health plans’ negotiated rates last month, so much has happened. We are thrilled to see price transparency starting to get some of the attention it deserves as a tool to support people as they navigate healthcare. We know from our annual consumer research that 81% of people want their health plan to give them the tools to save money on healthcare and we are proud to be part of that solution. While MRFs are a step towards a foundation of transparency, this first step is not enough.

Avoid surprises when planning for the next phase of transparency

To meet the requirements and deadline of January 1, 2023, plans need to leverage MRF data in the self-service tool for members. We can’t stop there. There are risks to using the MRF data alone. Three that come to mind are:

  • Rates could be displayed for providers in specialties irrelevant to the service a member is searching for–such as a behavioral therapist coming up in a search for surgery
  • Cost estimates must be delivered at the provider and location level to meet compliance requirements, and this information is not included in MRFs, so provider data will need to be integrated
  • Costs for individual items and services from the MRF–usually represent just a portion of the care experience for members

Don’t make people do all the work when looking for the cost of care

Let’s dig into the last point above. Since MRFs only provide rates at the item and service level, unless specific pre-negotiated bundles are included, someone searching for an ACL surgery would only get the surgeon fee. Clearly there’s more to the out-of-pocket cost for ACL surgery from check-in to check-out. The member experience should present members with the full anticipated list of services. We also know from consumer research that members want to understand what the end-to-end episode of care looks like–from evaluation through recovery. Shouldn’t they know what’s involved when planning their care in terms of time and likely additional expenses and possible alternatives?

Thinking about TiC differently with HealthSparq

Our team is using our decade of experience to help clients reduce the burden of compliance by delivering the required transparency elements and helping them improve member satisfaction by going beyond the mandate. From providing actionable guidance on services, to showing estimates from check-in to check-out, and sharing the big picture of what’s involved in their care, we’re guiding members to the right care to help the plan, the group, and the member save.

HealthSparq works with some of the largest health plans in the country to support their member-facing transparency and guidance needs. Our HealthSparq One platform offers:

  • MRF development and hosting, including reporting and analysis to understand download trends, as well as event-level details for supplemental reporting requirements.
  • Support for federal member-facing online, phone and print price transparency requirements for the January 1, 2023 and January 1, 2024 milestones.
  • Support for state-level price transparency mandates.
  • Robust, compliant provider search capabilities to help members find trusted providers, including the ability to augment provider data, share reviews, and schedule care online.
  • Incentives programs to guide members to cost-effective, quality providers and deliver savings for your plan, your groups, and your members.

Contact us to learn more about how HealthSparq can support your CMS price transparency compliance needs, and more.