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Healthcare Transparency - The Solution

Posted by Health Entrepreneur 03/01/2016

Investments in health information technology is necessary to ensure the right information at the right time to patients, payers and providers. Changes in the current methods of payment can increse transparency. It can be solved by publicising the patients condition by using the assistance of medicare.

To learn more about “Healthcare transparency - The Problem”, click here!

 

What can be done to achieve transparency in health system?

 
  1. Investments in health information technology, which is seen as necessary to ensure the right information is made available at the right time to patients, payers and providers.
  2. Making fundamental changes to current methods of payment can help increase transparency.
  3. Making patient’s condition publicly available can be made possible using the assistance of Medicare which can assume a leadership role in making provider’s quality and cost information available. Medicare can forge public-private partnerships by which they can create uniform quality metrics, multi-payer database, and transparent methodologies for adjusting the cost and quality.
  4. There should be a modification in the HAS legislation to reduce the potential harmful effects on a vulnerable population. With high-deductible health plans there is an increased risk that patients will fail to get the early care that could detect the serious condition in an early stage. This could further lead to patients not getting the right medication that could control the risk factors as well as other chronic conditions. The legislative modifications to minimize these risks could be:
  5. Where there are lower age workers the HAS deductibles allowed for them should be lower.
  6. For those employers covered under employer’s plans there should be a guaranteed choice of comprehensive health plans.
  7. The areas of primary care and preventive services should be made exempt from deductible. Prescription drugs should also be given an exemption since these may be used in the management of chronic diseases.
  8. There should be great flexibility in benefit design.
  9. There should be a ceiling on the income on eligibility for HAS so that there can be a reduction in tax subsidy for high-income individuals.
  10. There has to be fundamental change in the payment methods. There has to be gains in efficiency and quality which needs to be achieved simultaneously.

Key Elements of a Fully Transparent Health Care Marketplace

 

How can entrepreneurs leverage this market and take advantage of the lacunae?

Under the circumstances healthcare providers are fighting hard to provide transparent and understandable pricing, and they all have a long way to go. They are all lacking in skill sets and business models should be able to clearly define service bundles that need to be priced thereby making the pricing understandable to buyers. Manageable pricing is important too. One price fits all, or different prices in different cases?

Who are all stepping in to fill the gap?

Software technology entrepreneurs are one of the many who are utilising this opportunity and this started health insurance shopping sites such as ehealthinsurance.com and information sites such as WebMD.

 

Online health insurance purchasing got into mainstream sometime last year and led to launch of public exchanges. There is an array of start-ups which are in the health care transparency market and famous among them are:

  • CastLight (provides healthcare price information for employees of self-insured companies.

  • Care.com: helps you find in-home care givers

  • 23andMe: Aids in accessing personal genetic information

  • BestDoctors: Helps you find doctors for second opinions

  • ZocDoc: Helps you find doctor and schedule appointment on-line

  • TruVeris: Helps in bringing in transparency in pharmacy benefit manager pricing for payors

  • Pokitdok: Helps you find a doctor and obtain price quote

  • GoodRx: Helps you find discount coupons for prescription drugs

 

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