Imagine360’s new chief product officer, Nilima Rajkumar, has concerns with pricing transparency in healthcare, specifically how traditional insurers may go off of hospitals’ chargemasters.
“[Insurers] are offering you a discount, but it’s like, a discount off of what?” she said in an interview with Becker’s. “That piece is not always very clear.”
Imagine360, which specializes in offering employers self-funded health plans, uses reference-based pricing along with contracts for select health systems as an alternative to traditional insurance models. Ms. Rajkumar said the insurer often uses Medicare rates as a pricing benchmark.
“Payers have to do a lot of investment to meet all of the requirements related to [CMS’] Transparency in Coverage [rule] — make sure that we have the tools in place so that members could understand costs, member liability, etc.,” she said, referencing federal standards. To comply, plans must disclose pricing through machine-readable files and online price comparison tools. “That said, it’s still difficult to understand what is the impact to you as a member.”
Some insurers are going all in on AI and technological advancements in hopes of boosting efficiencies, but “sometimes technological innovation doesn’t translate to reduced cost,” Ms. Rajkumar said. When it comes to managing costs, Ms. Rajkumar emphasized the importance of the insurer’s network.
She also thinks there is one question employers — especially those that are small and midsize — are asking, but perhaps not often enough: “What am I getting for my dollar?”
Ms. Rajkumar said employers may consider traditional, fully insured products as their only option. As premiums go up each year, “there’s always some hand wringing.”
“There are alternatives,” she said. “Employers should be asking and really doing the research to be like, ‘What are my alternatives?’ and understand what’s the cost-benefit.”
