The ConnXion – VOLUME 01, ISSUE 01
In late 2020, Congress passed the Consolidated Appropriations Act (CAA) and Transparency in Coverage (TiC) Rule, establishing strict measures of enhanced transparency in health care to protect consumers from surprise billing. One of the most notable components stemming from these laws is the requirement that health plan administrators offer a web-based price transparency tool, effective January 1, 2023, to communicate the expected costs of services provided in a plan member’s service area, enabling them to compare cost amounts for items and services of in-network providers for specific regions.
So, with all this pricing transparency and comparison-shopping capability, employer groups can expect to see huge savings right out of the gate, right?
In truth, the answer to that question is not as obvious. As of the publishing of this article, price comparison shopping tools have yet to be fully implemented in the health benefits space. However, as an industry leader in administrative benefits technology, and with a behind-the-curtain and categorical understanding of how price comparison tools can and will benefit businesses when designed and implemented properly, we offer the following guidance on how they work and a timeline overview of what businesses can expect from them now, and in the future.
Price Comparison Tools: 2023
To best understand how price comparison tools work, it helps to know their legal requirements. Understandably, there have been some common misconceptions regarding what is initially required of these tools. One such misconception is that the tool must include some type of “price comparison” search engine, wherein a user can input a medical service and expect to see an all-inclusive breakdown of competitive provider rates in their service area. This, however, is not the case.
In actuality, the only requirements in this regard that must be met for plan years in 2023, effective January 1, 2023, is the offering of a pricing tool that provides cost-sharing information for 500 shoppable items, services, and drugs identified by the Departments in the TiC Final Rules, with health plans and issuers also being required to provide this information in paper form upon request. In addition, plans and issuers are also required to have the capability to provide this comparison information over the telephone.
Given that initial requirements, for 2023 plan years, will be limited to 500 shoppable items, services, and drugs, rather than having price comparison information available for all covered items, services, and drugs, it’s reasonable to expect that plan participants will have a somewhat limited scope of choice when vetting their options. Another interesting point to consider is the possibility that plan participants will not necessarily opt for a lower-priced service, item, or drug when weighing the potential for a perceived loss in the quality of said service, item, or drug. It could be advised for employer groups to temper their expectations for instant savings out of the initial rollout of price comparison tools in 2023, and, instead, look to 2024 and beyond for a heightened shift in competitive shopping capabilities.
Price Comparison Tools: 2024 and Beyond
The reason why 2024 will be a crucial year in the price comparison tool requirements timeline, is that starting January 1st of that year, health plans and issuers will be required to provide cost-sharing information for all covered items, services, and drugs. With this broadened range of selection, it can be expected that group plans and participants will be granted access to an ultra-capable competitive shopping experience compared to the year before.
Additionally, health plans, issuers, employer groups, and plan participants, will have had at least some measure of experience in price comparison shopping practices, including the added benefit of fine-tuning any educational components (member outreach, plan participant training) that could potentially increase the overall effectiveness of tool usage. The bottom line: the level to which businesses may see enhanced long-term benefits from price comparison shopping tools could very well be relative to how well-designed, fully capable, understood and utilized their tool is.
But why wait until 2024 for access to full price comparison tool capabilities? With WLT’s MyMedicalShopper price comparison tool, powered by TALON, your business is uniquely positioned with instant and exclusive access to THE leading provider of price comparison shopping technology and full-compliance readiness, both now and for the future.
MyMedicalShopper is a revolutionary and real-time healthcare comparison shopping platform, granting users access to proprietary machine learning technology and a massive data warehouse of more than 3.7 billion annual medical claims to help tackle the potentially crippling impact wasteful spending has on group plans.
Our data shows that prices paid for medical tests and procedures by employer-sponsored health insurance patients vary wildly across healthcare providers, and that plan participants often pay anywhere from 5 to 20 times more than they need to.
Based on our estimates, annual wasteful spending nets the following totals, depending on group size:
|Group Size (Employees)||Wasteful Spending Per Year|
With MyMedicalShopper, Powered by TALON, your business and members are granted access to a suite of solutions that empower consumerism and drive huge savings in healthcare – with full compliance readiness for 2023, 2024, and beyond:
- Makes shopping for medical care as easy as a Google search
- Unlocks savings on more than 10,000 medical tests and procedures
- Empowers administrators to make data-driven decisions – not guesses
- Provides data-based insights for strategically driving down costs
- Works across 130+ insurance carriers and health plans
- Easy access via seamless website and mobile apps for Apple and Android
- Provides behavioral engagement between employers and employees through behavioral economic expertise
- An employer dashboard arming employers with actionable insights that no other solution provides
- MyMedicalRewards, a customizable member rewards component that aligns the financial incentives of each business and their employees, rewarding plan participants for smart healthcare consumerism
- Comprehensive Advanced Explanation of Benefits (AEOB) functionality
- Plan advisory support
- Plus, much more
Simply put, when employee engagement and consumer incentives of price comparison shopping are increased, the impact it can have on group plans is immense. Power your business and members with the all-inclusive benefits of a price comparison shopping tool that addresses the compliance needs of today – and tomorrow.
Stay ahead of the curve and address future compliance issues today: