This IDC Perspective presents what is required to fully embrace price transparency throughout the payer enterprise. CMS mandates for payers and providers have emerged in response to "surprise billing" and a political response to consumer frustration with the obfuscation of medical pricing. The hospital and insurance industry has responded that this is an expensive proposition with limited value. Architecturally, it is indeed complicated and expensive to do well.
"Price transparency at a cursory level has been around for years, barely used by the average consumer. It was restarted as a political talking point and now has legs with mandates. Significant technology enhancements are necessary if it is to be totally realized in payers," states Jeff Rivkin, research director, IDC Health Insights. "One can doubt whether 'all' procedures will actually require exact predictive transparency and whether there is a large consumer desire or medical literacy to actually shop for procedures. That being said, effective price transparency strategy by payers must be architected in the context of the consumer and patient experience and involves significant front-, middle-, and back-office modification; analytics; and coordination with providers. Payers should determine early if they want to do the mandate minimum or factor price transparency into enhancing the member's healthcare experience toward differentiating service excellence."