Taking Advantage of Pricing Transparency as Healthcare Becomes Increasingly Consumer-Centric

February Wise Healthcare Consumer Month

February is recognized as National Wise Health Care Consumer Month, established by the American Institute for Preventive Medicine. By raising awareness and opening dialogue, the Institute intends to make a long-term impact on the way healthcare consumers take personal ownership of their care. 


Healthcare Consumerism

Healthcare consumerism is a growing movement that is transforming the delivery of healthcare services. The term became noteworthy with the industry’s shift toward value-based care. Today, healthcare consumerism empowers patients with information so they can proactively make informed, cost-conscious decisions about their health.

Rising healthcare costs, and need to contain medical care expenses, is attributed to the increase in healthcare consumerism that places price transparency in the spotlight. Price transparency puts patients in the driver’s seat, and as a healthcare consumer, access to accurate provider and hospital fees and out of pocket cost of service before receiving care.

The internet and rapid advancement of information technology and mobile devices enable consumers to shop online for healthcare services. According to Forbes, consumers reported using an average of three different online sources when looking for a provider. Search engines were the most common source, used by 65% of respondents, followed by insurance websites (used by 45% of respondents) and hospital or health system sites (used by 43%).

The past year saw focus on rising health care costs and federal legislation that support employer-sponsored health plan access to affordable medical services with added levels of protection and fairness. To increase price transparency practices in healthcare, the Centers for Medicare and Medicaid Services (CMS) mandates that hospitals publish meaningful price information for patients. As of January 1, 2021, hospitals operating in the United States are required to provide clear, accessible pricing information online about the items and services they provide. This information will make it easier for consumers to compare prices, estimate the cost of care and confirm market value.

For participants in an employer-sponsored health plan, healthcare consumerism brings an opportunity to engage and better understand the explanation of benefits and financial liabilities of their plan. There also are strategies to take advantage of price transparency to capitalize on cost containment initiatives and fully optimize value. This insight has potential to transform an employee’s health benefit plan, putting the economic purchasing power and decision-making in their hands. This empowerment is especially important in today’s economy. Many workers are “financially fragile” and have not set aside savings specifically earmarked for out-of-pocket medical expenses, including regular cost sharing – deductibles, copayments, coinsurance.

Health savings accounts (HSAs) are like personal savings accounts, but the money in them is used to pay for health care expenses. The idea is that people will spend their health care dollars more wisely if they’re using their own money. HSAs have evolved as part of a “health and wealth” rewards strategy. Funds pay for eligible health care expenses and for out-of-pocket costs a health plan doesn’t cover. In addition to funding current or future medical costs, HSAs offer tax-preferred utility capable of quadruple duty. Contributions receive the most valuable benefits tax preference offered by the IRS. More items qualify as eligible expenses under HSAs than under flexible spending accounts (FSAs). Contributions to HSAs are not subject to federal income tax, and the earnings in the account grow tax-free. Unspent money rolls over end-of-year, available for future health expenses.

Your Billing Partner

aequum helps plan sponsors, administrators and participants by adding additional layers of protection and price insight through our software and data-driven solutions. As your medical billing partner, we are here to support your plan for success in 2022! Please contact us if you have any questions.