UCare taps HealthSparq to power price transparency technology

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Photo: Mongkhonkhamsao/Getty Images

UCare, a nonprofit health plan serving Minnesota and western Wisconsin, tapped healthcare guidance and transparency technology company HealthSparq for a pricing transparency solution months before the Centers for Medicare and Medicaid Services rule does not go into effect for payers.

The partnership aims to give members more personalized and accurate cost estimates for health services for the approximately 600,000 members served by UCare.

The health plan anticipates that once the technology solution is implemented, it will make it easier for patients to plan the financial aspects of their healthcare and provide them with a digital experience.

HealthSparq also promises to provide information to members with its treatment timeline tool, which estimates both how long care will take and all the costs involved, from assessment to recovery for complex care such as surgeries.

WHAT IS THE IMPACT

The priority for UCare is compliance with the Centers for Medicare and Medicaid Services self-service mandates for health plans, which go into effect in 2023. The October 2020 CMS final rule requires members to have access to online price transparency tools.

According to CMS, starting July 1, most group health plans and issuers of group or individual health insurance will begin publishing price information for covered items and services.

This price information may be used by third parties, such as researchers and app developers, to help consumers better understand the costs associated with their care.

Additional requirements will come into effect from January 1, 2023 and January 1, 2024, which will provide additional access to price information and ostensibly improve consumers’ ability to purchase the healthcare that best meets their needs. .

In plan or policy years beginning on or after January 1, 2023, most group health plans and issuers of group or individual health insurance coverage will be required to disclose personalized pricing information for all items. and covered services to their participants, beneficiaries and registrants through an online consumer tool, or in paper form upon request.

Cost estimates should be provided in real time based on cost share information accurate at the time of the request, CMS said.

For health plans and insurers, key provisions include making pricing information publicly available, including in-network rates and authorized amounts in machine-readable files and providing a price comparison on the Internet. Recipients should have an idea of ​​their out-of-pocket expenses so they can purchase items and services efficiently, CMS said.

Controversially, the final rule also requires plans and issuers to disclose in-network provider-negotiated rates, as well as historical out-of-network authorized amounts and drug pricing information.

The Department of Health and Human Services has also finalized changes to its medical loss ratio program in the rule that allows issuers offering group or individual health insurance coverage to receive credit in their MLR calculations for savings. that they share with enrollees that result from enrollees’ purchases, and receive care from lower-cost, higher-value providers

For plans that are non-compliant, CMS may take enforcement action in a number of ways, such as requiring corrective action and/or imposing a civil penalty of up to $100 per day for each breach and each person affected by the breach.

THE GREAT TREND

Hospitals have their own requirements for price transparency, but a recent survey by patientrightsadvocate.org found that to date only 14.3% of 1,000 hospitals comply with the rule.

About 38% of hospitals surveyed posted a sufficient number of negotiated rates, but more than half failed to meet other criteria in the rule, such as the rates for each named insurer and plan. At the same time, only 0.5% of hospitals in the country’s three largest hospital systems – HCA Healthcare, CommonSpirit Health and Ascension – were compliant.

The most common omission labeled as “non-compliance” was the lack of or incomplete display of negotiated prices for each item and service clearly associated with all payers and plans accepted by the hospital.

Twitter: @JELagasse
Email the author: jeff.lagasse@himssmedia.com

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