November 15, 2019

Going Beyond the Price Tag in Healthcare Transparency

The Centers for Medicare and Medicaid Services recently issued two rules aimed at giving consumers access to more information about the cost of common healthcare services. We are glad to see progress in the national conversation, and while there will certainly be additional developments as the government seeks to implement these rules, we believe this is positive momentum toward an improved healthcare experience for all Americans.

Castlight was founded on the idea that our healthcare system should be transparent to patients and that through empowering individuals with access to their own healthcare information, they can make more informed decisions. Over the last decade, we have fought for healthcare transparency and are proud to deliver a cutting-edge, personalized health navigation experience that includes provider cost and quality for more than 20 million Americans today.

In that time, we have learned—along with our large employer and health plan customers—that providing price information passively will not equip consumers with the information they need to make the best decisions for their health. Making informed healthcare decisions is much more complex than simply checking a price tag.

First, pricing information should include the total price for all of the services related to one event. For example, for maternity, cost estimates should not only include delivery, but prenatal visits and routine postpartum care.

In addition, providing accurate price information is complicated by the fact that healthcare prices are personal. To deliver people the right care for the right price, we must combine the negotiated prices for services with the patient’s plan design and deductible to show true out-of-pocket costs.

But price is not the only, nor the most important factor people consider when making healthcare decisions. Other factors to consider when choosing a provider include quality, referrals, personal preferences, and convenience. Truly delivering a better healthcare experience for patients requires these elements to be included in the solution, which also drives a direct impact on lowering costs.

Finally, to deliver the outcomes we all want—lower priced, higher quality care, patients need deeply personalized recommendations that incorporate their own conditions. For example, if Nancy has diabetes, she should be guided to a primary care physician who has experience treating people with diabetes. Patients using primary care physicians recommended by Castlight’s SmartMatch technology not only experience 15% fewer inpatient hospital days per year, but also 8% lower total medical spending per year.

These new rules are a step in the right direction. However, we must go further to really transform the patient experience. A holistic approach offering cost and quality in a personalized, consumer-oriented experience is required to truly enable better healthcare decisions.

We look forward to continuing our quest to make it as easy as humanly possible for Americans navigate the healthcare system. We have been delivering on the requirements for delivering transparency to our customers and users for over 10 years and look forward to these rules emphasizing the importance of health navigation.

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