Amid the difficult healthcare environment, it's important to note that there have been some wins for employers, said Katy Spangler, senior advisor of the American Benefits Council, during the Midwest Business Group on Health conference held Tuesday. These wins include the No Surprises Act and price transparency rules.
CMS recently fined two hospitals for alleged violations of its price transparency rule. These fines are only the third and fourth penalties issued by the agency since the rule took effect on January 1, 2021. These fines may become more common — CMS also announced that it is updating its enforcement process for the rule.
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
As a first step to move toward greater hospital price transparency and lower costs, CMS can immediately issue $2 million fines on the 30% of American hospitals it concludes are noncompliant. If CMS takes enforcement seriously, the hospital industry will respond by quickly coming into compliance.
It’s not enough to be hopeful that hospitals with the right tools—and incentives will put prices out there on a menu for all to see. Luckily, for employers and employees who want to access affordable healthcare, new and emerging solutions are empowering them with information and options.
Aneesh Chopra, president and co-founder of CareJourney, predicted accelerated enrollment in value-based care models in 2024 and 2025. He thinks this will greatly increase healthcare transparency for a few reasons, including making data more available and influencing more primary care doctors to act as health information fiduciaries on behalf of their patients.
Price transparency has come a long way over the past couple of years, with insurance companies and hospitals now required to publicly disclose their prices. The more pressing issue is that there is no mechanism in place to make this information easily digestible, personalized to each patient, and placed in context with competitors’ prices.
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
Transcarent wants to transform the digital pharmacy benefit experience, enabling self-insured employers and their staff to make more informed choices.
Payers and providers face different challenges when it comes to compliance. The volume of price transparency data that hospitals must disclose online amounts to about 3 terabytes — compared to the whopping 630 terabytes of data that payers have been tasked with posting.
Price transparency data has revealed there is a high degree of price variance for healthcare procedures depending on patients' insurance carriers and the location in which services are delivered. Jaewon Ryu, Geisinger’s president and CEO, said that the only way this variability can be addressed is by getting decision makers on the payment side much more aligned with the care delivery side of things.
The healthcare industry is still building software to can handle its complex and vast pricing data, so it still has a few more years to go before price transparency information actually becomes useful. Once software development cycle matures, this data can infiltrate the way providers and payers negotiate contracts and affect the way patients shop for care.
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
TALON was recently crowned winner of the Pitch Perfect contest at MedCity's Invest Digital Health conference in Dallas. The company offers a suite of solutions to help stay compliant with the Transparency in Coverage Rule.
The question elicited predictable and unexpected responses from panelists that included a senior executive from CVS Caremark and executives from startup companies working to change the pharmacy benefits landscape.
Virginia-based Careviso recently raised $17 million in Series B funds. The company — which is focused on improving transparency and access for diagnostic testing — will use the funds to enhance its platform's price transparency tool and deploy it in physician offices so it can be used at the point of care.
The patient financial experience in the U.S. is poor — patients have a hard time understanding pricing data and they often face exorbitant prices for care and medications. This problem will only get better if the healthcare industry rids itself of price-gouging middlemen and closed-door price negotiations held by businesspeople, according to a recent healthcare innovation panel.
Legislative solutions to expand healthcare pricing transparency have fallen short, but that doesn't mean we're out of options. Emphasizing technological fixes and collaborative solutions show promise for a complex problem.