Sponsored content from NFP

Balancing Cost and Quality with Price Transparency Tools

Presented by: Bryan Brenner, Managing Director, NFP; Megan Nail, CCP, SHRM-SCP, CEBS, VP, Total Rewards Practice, NFP; and Heidi Cottle, SVP, Cost Containment Strategies, NFP

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Across the country, businesses are looking to reliable data metrics like healthcare price transparency tools, advanced data analytics and actuarial predictive models to find healthcare offerings that provide quality care at a reasonable cost.

To stay ahead in the race toward healthcare value while mitigating their growing fiduciary risk, employers must use data as a foundation of a well-developed due diligence process. Using key data metrics, employers can target areas for greater personalization of healthcare benefits to satisfy the complex needs of five generations in the workforce and their varying healthcare needs.

Benefits of Using Price Transparency Data

For the first time, healthcare price transparency laws empower employers to compare publicly posted negotiated pricing across the universal healthcare landscape — giving the ability to assess the cost of a medical procedures in advance of care.

Employers can analyze claims data to understand historical costs and use transparency pricing combined with actuarial science and advanced analytics for more accurate financial forecasting. This empirical data will assist employers in determining more effective ways to reduce costs, improve quality and minimize disruption to members under their employer group health plan(s).

Organizations that invest time to develop a proactive value-based healthcare strategy and incentivize member usage of high-quality, low-cost providers see financial results. Early adopters leveraging publicly available pricing data are realizing renewal savings ranging from 5% to 18% depending on their strategy, incentives, and use of high-performance providers.

Making Data Actionable

Due to the size of the transparency data, technological tools, including an enhanced tool stack are a necessity to make the data actionable. NFP offers two pivotal tools for healthcare cost management, TPNet and TPCompare, which support different needs and users.

TPNet is a strategic tool for employers and advisors which enables employers to benchmark providers, facilities, and carriers/payers to compare healthcare offerings against the best-negotiated plans in the country. High performance networks can be independently evaluated nationally, regionally, or locally. This tool provides:

  • Network price comparison by plans and issuers (payer).
  • Provider quality performance.
  • Strategic evaluation of high-performing, lowest (reasonable) cost providers.
  • Foundation of a fiduciary due diligence process.

TPCompare, on the other hand, is a commercial business intelligence pricing tool offering benchmarking for both price and quality to support healthcare providers to be:

  • Competitively positioned in the market based on medical cost and quality metrics.
  • Empowered with empirical data for contract negotiations.
  • Positioned to preserve and grow revenue.
  • Leverage aggregated technology to reduce expenses.

These tools are a key aspect to making price transparency work. “Healthcare transparency, much like pay transparency, is good for the American worker,” says Bryan Brenner, managing director, Benefits. “Employers will now become empowered to choose value-based care and look out for employees and their families. The black box of healthcare and insurance reimbursements is rightly opening up to those that pay for it – employers, workers and all American people. We all deserve high quality, cost-efficient care delivered safely and effectively. I’m thrilled to play a major role in Indiana to drive this healthcare transformation. It’s time.”

Benefits Participation and Healthcare Literacy

In truth, most people don’t take full advantage of all the bells and whistles that come with their benefits. Regardless of demographics, an ongoing challenge is healthcare literacy. The lack of healthcare cost transparency has too often led to ill-informed healthcare consumers. Providing support solutions (such as by providing access to clinical care navigators), educating employees and promoting benefits features are great ways to ensure full value from investments in benefits.

Improving Your Competitive Edge

Leveraging transparency data analytic tools gives employers a new competitive edge through the ability to assess cost and quality in advance of health care services. These types of innovative strategies will distinguish an employer and enhance their ability to attract and retain employees, mitigate risk, and identify ways to improve outcomes.

In the face of rising healthcare costs, employers that find comprehensive solutions to make healthcare valuable and more affordable without compromising quality are often more profitable and create a winning culture. While there’s no one-size-fits-all solution, using tools and technology to gain visibility into the cost drivers is a significant step.