How to drive high performance by tuning your transparency cost tools

September 30, 2015 Ray Catudal

Your website is ready for open enrollment with the latest updates and consumer friendly decision support tools. Great! Once you have made it easy to choose a health plan and consumers have enrolled, what’s the next big challenge you need to consider? Helping consumers understand their policy and guiding them to use their benefits in smarter ways should be next on your list.

According to a recent AFLAC study, “the complexity of benefits plans, coupled with employees’ lack of preparation, appears to be having a negative effect on how much employees actually know about their policies.” The study found that 44 percent of employees say there are some things they don’t understand about their policies, and 9 percent say there are many things they don’t understand or they don’t understand their policies at all. This means that once members need to utilize benefits, they really do not know what to do or where to start.

The lack of knowledge and understanding has escalated particularly now because consumers are in the driver seat of their own healthcare. High deductible health plans and HSAs are increasing and according to Kaiser, employer sponsored health premiums will continue to rise, further contributing to the consumers lack of knowledge about their policies.

Mind the Gap

One big gap for consumers is the costs associated with their plans. Because consumers are increasingly responsible for more of their health care costs in these plans, they also have higher expectations of their health insurance and benefits selection/enrollment experience. As a result, consumers are becoming more cost conscious when it comes to utilizing their health plans. Members are already asking more questions about what services will cost and what quality they can expect.

That’s where transparency tools come in.

Amazing Xray VisionSome carriers are making these tools more widely available. One example is from the Blue Cross Blue Shield Association (BCBSA) with their new BCBS Axis, the largest database for health plan cost and quality information. The database will allow consumers to “locate the right doctor at the best value and make better informed, personalized healthcare decisions.” It includes data from 2.3 billion procedures performed annually and from over 90 percent of physicians and hospitals. Aetna and Cigna have similar tools available for consumers. 

Similarly, Priority Health has partnered with Healthcare BlueBook to help people research hundreds of procedures, like lab tests, MRIs and non-urgent procedures to better understand costs.

These are all great tools. But you need to get the consumer to the right place before they can use these tools. In some cases, these tools just add complexity and confusion to the equation. While meant to educate and provide better assistance, consumers can easily by pass the tools out of a lack of understanding or information. It becomes even more challenging with external tools and sites like that is sponsored by the Health Care Cost Institute.

In addition to cost transparency tools, there are also quality transparency tools, like, or or Combining cost and quality transparency tools will help members find the best care option. But again, it all comes down to the consumer finding these tools at the point in time when they make the most sense and will provide the greatest benefit.

The more these tools start integrating with platforms and carriers, the better consumers will become at understanding and utilizing their benefits. But carriers need to go beyond just making these tools available. The sheer presence of these tools is not enough. Carriers have learned from the underutilization of previously released decision support tools like provider finders, subsidy calculators, etc. that the presence of tools does not equal an understanding of how to use them.

Driving Use

AHIP is encouraging insurers to make their transparency tools more meaningful and easy to understand. So, how can these portals actively engage members and make them aware of the tools that are available to them?

One way is through the use of virtual assistants. By deploying a virtual assistant on your site, they can be deployed as ‘engagers’ or 'guides' in many places to help members understand how to use these cost and quality transparency tools. These virtual assistants aren’t just a pretty face. They ensure the right information is being surfaced, they answer questions, and provide 24/7 support — in any language.

Using transparency tools may result in saving in thousands of dollars and will eventually increase competition, which is good for consumers. So, go ahead and leverage modern technology that engages consumers, so they can be guided to the right places to get the answers they need. But, don’t just deploy transparency tools without a plan on helping consumers engage with these tools. Don’t let consumers go crazy trying to figure all this out by themselves.

Thanks for reading.


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About the Author

Ray Catudal

As Director of Healthcare Consulting, Ray is focused on CodeBaby’s healthcare specific customers and delivering on CodeBaby’s mission of customer centricity. With over 20 years of experience in medical devices, healthcare and technology, specifically: ehealth, health insurance, and software, Ray is a subject matter expert who contributes to industry articles, and speaks at trade shows and events.

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