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By Navin Nagiah, MultiPlan Senior Vice President
Amidst a landscape of skyrocketing, unsustainable costs, reforms such as the No Surprises Act and Transparency in Coverage Rules are just the start of mass disruption in healthcare likely to be driven by increased government regulations, consumer demand, and private sector innovation.
With the many months of preparation for compliance with the new rules behind us, now is the time for payors to look at the broader trends driving reform, and develop strategies for long-term success in a rapidly evolving market. Instead of simply complying with new regulations, payors can leverage the forces behind them to improve their member experience, manage costs more effectively, and stay competitive as changes continue to unfold.
Here are three strategies payors should embrace as they face new regulations:
Think Beyond Regulatory Compliance
While current regulations force the implementation of price transparency tools, payors that go beyond doing the bare minimum to comply with the regulations but instead look at the market trends driving the regulations and respond with both product improvements and the build-out of new products and offers that align with those trends will be best positioned to benefit most from the new rules.
The key is to focus not just on the literal or legal interpretation of the rules but also on the intent behind them, the impact they could have on both member and provider behavior, and the possible new opportunities for value creation and problem-solving that this offers them.
After all, new transparency measures will only be effective in bringing down costs if patients adopt new shopping behaviors and seek out the information provided. Beyond checking the box toward implementation, payors should develop a strategic roadmap to drive member adoption of pricing tools and educate them on how to become active participants in managing the costs of their care.
Keep Consumers at the Forefront
Consumerism is a trend that is leading healthcare in 2022. Raised in a digital-first world and bearing more of the cost burden for their care, a new generation of health consumers expect convenient, affordable, and quality care on their terms. They want greater price transparency, better digital tools, and the ability to get care when and where they want it. While the effects of consumerism will hit the self-pay market first, payors should take note of the shifting balance of power in healthcare and evolve plans to put members at the heart of their offerings. Compliance with new transparency measures is a good first step and presents an opportunity for the type of digital innovation consumers crave from their health plans.
Build a Culture of Collaboration with Providers
Now more than ever, greater collaboration between payors and providers is required to meet advanced EOBs requirements. This presents a unique opportunity to innovate and experiment in new communication channels, cross company data inter-operability initiatives, tools, and platforms which will be imperative as the industry shifts toward value-based care models. Establishing a more collaborative culture with providers is essential to evolve from a transactional model toward a patient-centric system of care in which providers and payors share an interest in keeping patients healthy. Those payors who use this opportunity to seek collaborative partnerships with their provider networks and members position themselves to reap the benefits, driving bottom-line savings through reduced administrative costs and improved patient outcomes.
While we certainly can’t ignore the immediate administrative hurdles payors face in achieving compliance with new and emerging regulations, those that take the opportunity to look at the big picture and choose to embrace and innovate through change will see the most significant outcomes and position themselves for a stronger future.
About the Author
Nagiah brings extensive experience to MultiPlan as a strategist, entrepreneur and growth leader, having built four high-tech companies in over two decades. Prior to MultiPlan, Nagiah worked in McKinsey & Company’s health-tech/digital health domains and spent 20 years as a global entrepreneur and executive at multiple technology businesses.
MultiPlan Corporation (NYSE:MPLN) (“MultiPlan” or the “Company”) is a leading value-added provider of data analytics and technology-enabled end-to-end cost management, and payment and revenue integrity solutions to the U.S. healthcare industry. MultiPlan is committed to helping healthcare payors manage the cost of care, improve their competitiveness and inspire positive change. Leveraging sophisticated technology, data analytics and a team rich with industry experience, MultiPlan interprets clients’ needs and customizes innovative solutions that combine its payment and revenue integrity, network-based and analytics-based services. MultiPlan is a trusted partner to over 700 healthcare payors in the commercial health, government and property and casualty markets. For more information, visit www.multiplan.com.