How 3 Policies are Changing the Healthcare Payer Landscape
The Price Transparency Rule, No Surprises Act, and Access to Health Information Rule are forcing healthcare payers to change their strategies and adopt new technology, found Insights by Xtelligent Healthcare Media’s latest report.
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- In a new report from Insights by Xtelligent Healthcare Media, three recent healthcare rules are examined and their effects on payers are measured.
The first of the three regulations examined, the No Surprises Act, aims to protect privately insured patients from high medical bills that result from emergency care, ancillary services, or charges rendered without advanced notice.
Second, the Price Transparency Rule published in 2020 established that hospitals must make price information available to patients. To comply, payers will need to nail down specific pricing information and continue to update their rates on an annual basis.
The final regulation examined in the survey, the Access to Health Information and Interoperability of Health Information Technology Rule, focuses on fostering the modernization of payer IT infrastructure.
Notably, the Xtelligent report showed that the current understandings of the three new regulations are disjointed.
“We have our government and regulatory affairs team at an enterprise level, and we have our
compliance team within our department,” a product manager from a large insurer explained during a qualitative follow-up. “They work together to synthesize what we need to know in our design process and on the product side, and they distill that information down to us.”
However, confusion can grow as multiple insurers get involved with analyzing new rules. “What I do see that is interesting is the different companies and their lawyers interpreting the regulations differently and that's not helpful,” an independent broker noted in a follow-up call.
Survey respondents confirmed this confusion for all three rules: 43 percent claimed they were unsure about the requirements of the Price Transparency Rule; 33 percent said the same about Access to Health Information and Interoperability of Health Information Technology Rule; and 22 percent admitted confusion concerning the No Surprises Act.
Once insurers finally complete this legal unpacking process, they are still working to figure out how new rules change their product offerings and member engagement strategies. For example, early understandings of the Price Transparency Rule have changed the way that insurers engage with their members.
“We are increasing transparency on plans across group and retail, where we have to publish our rates and be transparent about how we're reimbursing providers,” one product manager revealed in a call with insights. “We are also working towards helping members understand the full breadth of what their healthcare costs could be for a service. The transparency ruling is crosscutting at a federal level.”
These new standards for data sharing, routine medical bills, and the ability to shop for services all indicate a more fruitful future for beneficiaries. For payers, compliance will be reached because their financial success rests on their ability to do so. However, the negative impact that these successive regulations may have on certain payers, providers, and their relationships is cause for concern.
To access the full report and learn more about how insurers are responding to regulation, click here.
