Beyond federal price transparency rules, there are more transformative policies that could be implemented to create a shoppable and consumeristic environment in healthcare, according to Harvard Business Review analysts.
Under CMS rules, hospitals have been required to make their prices for services publicly available since January 2021, while payers have been required to publish their negotiated costs for in-network services since July 2022.
Third-party companies have raced to extract the new data and turn it into consumer-facing healthcare pricing tools, but there's been significant challenges with noncompliance, the sheer size of the data files, and a lack of personalization because of the complexities in insurance coverage.
"The rules now in place are a major improvement over what existed previously, but they are not a complete answer. Policymakers should be willing to take the next steps and allow consumers to play their rightful role," the HBR analysts wrote Feb. 24.
Four suggested measures to improve healthcare consumerism:
1. Bundled services
Providers should be required to create and post prices for standardized bundled services for specific care episodes, like childbirth, with add-on services available for purchase.
2. Mandatory provider participation
If care bundles are available for consumers to purchase, then providers should be required to participate to create competition within a standardized system. Providers should also be required to post those prices regularly.
3. Universal prices
Posted prices for care should be simple — one base price for any individual who pays for the service, regardless of insurance coverage or negotiated rates.
4. Create price-informed consumers
Payers should be required to post the price for median out-of-network rates for services that have been standardized, which members could then use to choose a provider. If the provider charges less than the payer, the member gets to keep the excess, thereby encouraging more price competition and incentivizing patients to choose low-cost providers. The consumer savings could also be put into HSAs.