Delivering Transparency to Health Insurance Enrollees

A common healthcare frustration is getting the medical bill with surprising costs after receiving the care, procedure, or treatment. Out of fear of expensive care costs, it is not uncommon for people to either postpone medical treatment until their illness worsens to a dangerous, sometimes life-threatening state; forgo treatment altogether; or cut back on other essential expenses like food and housing to afford their healthcare costs. Medical care has become often unaffordable, and the decline in health is the regrettable outcome.  

There are additional steps insurers can take to provide not only better cost transparency but medical clarity to enrollees that will help them make more informed health decisions.  

Here are three ways SelectHealth, a nonprofit health insurer, works toward this goal. 

1. Cost estimator tool. Providing simple health tools to enrollees helps them become active participants, alongside their healthcare provider, in their health journey. This tool gives enrollees the ability to search and review approximate medical costs associated with a variety of care and services. For example, before having a procedure or more expensive service, enrollees can navigate through their member portal to the Cost Estimator Tool. There, they can review the cost of the particular procedure or service at various facilities and with different healthcare providers.  

2. Provider locator tool and provider reviews. Choosing the right provider can be difficult and stressful, and this decision-making often may delay care. After every visit with their healthcare provider, enrollees are allowed to review and offer feedback through comments about their experience. Providers are scored on a five-star rating system. When determining which provider to use through the Find a Doctor tool, enrollees easily see the associated star rating and can read positive and negative comments from real patients.  

3. Value-based care focus. The traditional approach of fee-for-service, where healthcare providers are compensated based on the number of services provided, is an underlying reason for higher and more frequent medical bills hitting enrollees’ accounts. The more recent shift to the fee-for-value model restructures this outdated model and pays healthcare providers based on the quality of service provided, patient satisfaction scores, and then total costs of care. This new model emphasizes healthcare providers delivering the right care at the right time, which reduces the use of costly services and prescriptions that may not be needed. SelectHealth partners with like-minded healthcare providers who see the importance of value-based care. These collaborations help keep care and services affordable (and accessible) for enrollees. 

Transparency across the healthcare and health insurance industries is an important step in improving healthcare and adding to the value-based care initiative. Medical costs are often unexpected even with thoughtful planning. However, insurers and healthcare systems can become an advocate for their enrollees and patients by providing tools and adapting processes that drive medical cost transparency. 

SelectHealth is a not-for-profit health insurance provider.