New Transparency Regulations: The Value of Exceeding Compliance

Today, Castlight is a leader in healthcare navigation. Our digital platform and team of highly experienced clinical and benefits experts (called Castlight Care Guides) provide members with a highly personalized and streamlined health benefits experience that drives better health outcomes and cost savings.

Our approach to navigation has several crucial components, with one of them being transparency. We developed our transparency expertise more than 10 years ago, in the early days of Castlight. That means that we are more than ready for the new federal transparency rules. It also means that we’ve learned a few key lessons along the way.

These new regulations are a great opportunity to renew the discussion about how transparency can be valuable to members. Below, we review what we’ve learned about transparency over the past decade, along with Castlight’s solution for each lesson learned.

4 Lessons Learned about Transparency

Lesson 1: Price Transparency Alone Is Not Sufficient

Knowing and understanding the cost of a healthcare provider or service is important, but in order for a transparency experience to be truly valuable to a member, price information needs to be paired with quality measurement details. However, while the upcoming regulations place a strong emphasis on price transparency, they neglect to stipulate any requirements related to quality.

Castlight’s Solution: At Castlight, we procure quality data from more than 30 reputable data sets, and we use this data to further personalize the healthcare navigation experience for each member. Based on historical claims and other member information, we can display quality metrics specific to each member’s situation. Quality data add an important layer to pricing data, further empowering members to make better decisions about their health.

Lesson 2: Simplify the Decision-Making Process

While consumers like to have choices, having too many options can become a decision-making barrier. If a member searches for care and the result is a list of every single provider who offers that care, the member then needs to scroll through that entire list and individually evaluate each one to determine the best fit. A huge cognitive burden and incredibly time-intensive, this can end up preventing members from getting the care they need, or from connecting with a high-value provider.

Castlight’s Solution: Leveraging more than a decade of data, our platform curates a more focused, tailored group of providers for each individual. When a member searches for a certain type of care, they’re presented with the top five recommendations (including the rationale behind each) specific to the member’s health needs, unique clinical profile, and preferences. They can still explore the full list of in-network providers if they want to, but we’ve found our proprietary SmartMatch leads to true behavior change and better outcomes.

Lesson 3: Human Touch Is Critical When Members Need It

The new regulations only align with members who prefer to completely self-serve — that is, those who don’t need anything beyond an easy-to-use, intuitive technology platform. There are rules for the types of tools and technology to offer members, but there’s nothing about how to assist those who prefer a more human touch. But both high-tech and high-touch are essential to taking care of a full population. Of consumers who experienced an acute illness, 32% did not rely on digital technologies for information.

Transparency data are complex. While it’s good members will now have access to more, it’s unprecedented for them to have access to this much. It’s likely many individuals will need help understanding exactly what all of this new-to-them information means — and the digital self-service model simply won’t suffice in all cases.

The Castlight Solution: Providing a diverse range of ways for members to engage with the transparency offering you develop is critical for maximizing its value. At Castlight, we emphasize the need for multi-modal communication — calls, direct mail, email, chat — to reach our members. And, of course, this is where Castlight Care Guides, our high-touch advocacy service, come in. Care Guides can assist members with navigating their personal health journey in many ways, including breaking down and interpreting transparency data.

Lesson 4: Self-serve Search Isn’t Enough to Promote Preventive Care

Just because you provide a transparency tool and enhanced search capabilities doesn’t guarantee members will use it at all, let alone regularly. You must take the extra steps to meet them where they are, whether they are trying to stay healthy, at-risk for chronic disease, managing a chronic condition, or navigating post-acute care.

Castlight’s Solution: We developed and honed our fundamental transparency capabilities more than 10 years ago, but we knew this wouldn’t be enough to affect real change. So, we kept building and iterating. Today, we can take every single piece of information we have available to us — claims data, biometrics, health risk assessments, social determinants of health, and more — and leverage it to personalize the healthcare experience for each user.

Leveraging predictive analytics, we segment the population into 190 segments that can be used to tailor recommendations and outreach for each member. When we do this, members are more likely to take action and start searching for the care they need, regardless of whether that comes from an individual provider, a virtual care resource, or a digital health program.

Moving Forward

As employer plan sponsors and insurance issuers prepare for the new federal transparency regulations, we strongly recommend going beyond compliance.

Because when you combine transparency with full population engagement, personalization, and digital and high-touch offerings, you create a health navigation experience that can yield an average monthly active user rate of 57%, close 28% more gaps in care, and result in an average employer healthcare cost savings of 1.5 to 3.2%.

Since you’ll already be investing in compliance and will have members’ attention, this moment in time is a great opportunity to re-engage the population, educate them on the importance of evaluating their care options, and make significant improvements to their overall health navigation experience.

Jake Fochetta is the director of Corporate Strategy at Castlight Health. An experienced healthcare IT professional, he has spent more than 10 years in enterprise technology strategic planning for hospitals and health systems, operational transformation, patient engagement, and virtual care strategy development.