Bringing context to cost for patients

More than ever before, the patient has more responsibility for the health care dollar. Right to shop legislation is being approved in more and more states adding to the more unique strategies being introduced by payors.

It seems likely that Hospital Transparency Rules that were just upheld by a federal court will soon require facilities to post payor-negotiated rates for 300 services, and changes to Medicare Advantage and Interoperability rules will soon be in place. The COVID pandemic is altering the market landscape with anticipated pent-up demand for services, more cost-conscious consumers, and users struggling to navigate the healthcare system.

Additionally, in this age of consumerism, patients want a connected customer journey that enables the most efficient path to care. It is critical for hospitals and health systems to understand patient needs and wants. Knowing the holistic cost of care of a specific procedure is meaningless because the patient will not pay that amount. Part of your patient engagement process should be educating your current and future patients what’s meaningful to them – What are they specifically going to pay out-of-pocket for care at your locations?

The challenge and the opportunity

  • There is a need to drive a cost that is competitive while maintaining quality standards
  • Facilities need to be focused on continually adding and enhancing new capabilities and integrating third party solutions to improve patient experience and outcomes
  • Integration with strategic partners is of added importance
  • The patient experience becomes substantially more important, and with it, a requirement for more evolved user testing and research
  • The ability to accurately reflect costs for procedures is taking on greater prominence
  • A commitment to identifying macro industry trends as well as regional requirements is needed to assure that the transparency offering meets ever-changing needs
  • Tightening the patient experience and connection with payor costs to ensure the customer is not confused about costs presented between payor and provider. 

Addressing these challenges requires teams with a wide range of expertise in UX design, testing strategies, data ingestion and management to enable patients to appreciate the financial impact and value of intelligent healthcare choices, and, of course, an infrastructure that is both secure and scalable. And perhaps more important than ever before, it requires a partner singularly focused on assuring both compliance and effective delivery of the needed capabilities.

CareSelect for Hospitals & Health Systems

Sapphire helps over 100 million people find and understand the cost of care using real-world, claims-based health care data. As an organization, we’re on a mission to enable, guide, and empower customers to control their health financial picture. We do this by making it simple to find, select, and control costs before, during, and after their health event. With nearly 15 years immersed in the complexities of cost and data, and delivering transparency answers that show costs and member liability, our tools are a perfect starting point for health systems and hospitals looking to deliver consumer-friendly pricing on shoppable procedures. Our CareSelect platform can help hospitals and health systems:

  1. Get patients to get the right care while helping them budget for the cost.
  2. Create a destination for passive patients who haven’t yet decided on a care option to become active patients by making procedure cost easier to find.
  3. Engage existing patients by promoting services, providers, and facilities in multichannel tools that connect right to the details they are seeking.
  4. Incentivize behavior with cash and non-cash incentives through our SmartShopper add-on.

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