Looking beyond price transparency to get employees better healthcare

Healthcare.Bloomberg.7.20.17.jpg

Providing employees with information on healthcare pricing is important as it allows them to make informed decisions. Lack of pricing transparency is often cited as a reason that employees choose to forego care, leading to gaps in care and medication adherence issues. While critically important, price transparency is just one piece of the puzzle in helping employees get the right care.

In our 10 years of helping employees find care on the basis of cost and quality, Castlight has learned we needed to do more to proactively meet our users on their care journeys. We developed machine learning based models to identify and predict care needs so that we could proactively help our users find the right care. For example, we are able to leverage claims data, demographics and search patterns to identify a user at risk of back pain. We can then connect that user to a physical therapist leveraging a combination of personalized messaging and our transparency solution. Put simply, personalization is key to helping employees get the right care.

We also realized just how significant a shift it is for employees to use technology to find care. Employees require simplification and an “answer first” approach to design. One of the things that is better understood today than 10 years ago, is just how vastly provider quality and true costs vary. Employees struggle to understand how to interpret physician volume and or adverse outcomes or readmissions rate — simplifying this data into a set of recommended providers (a virtual network) versus a list of providers is a must to impact consumer decisions.

We are all seeing many exciting changes in healthcare — changes in delivery models, greater focus on primary care, and shifts to virtual and retail care. We have also seen the introduction of hundreds of digital health therapeutics and point solutions. The system is changing rapidly, but complexity remains a constant.

In the face of this complexity, we have observed employers deploying three strategies to augment price transparency tools:

1. Network strategies. Employers have implemented a broad range of network strategies, from health plan high-performance networks, to carved out relationships with providers, to procedure-specific centers of excellence. Given the massive provider variance on cost and quality, narrowing the network is an important strategy to help people get the best care. However, many employers don’t have the bandwidth to take on network carve outs, and we see an opportunity for those employers to adopt virtual network strategies, which is effectively leveraging technology to guide to a short list of providers.
2. Single place to go. Employers have embraced simplicity and are looking for a one-stop shop, across not just medical, dental and pharmacy, but also financial and other benefits. We see employers choosing to adopt technology solutions or go with a high touch, call center-based approaches. We believe that there likely needs to be some of both to really meet user needs.
3. Personalization. Employers share an understanding of the criticality of personalization to drive behavior change. We have seen different approaches, from leveraging health plan capabilities to using triggers from data warehouses to adopting navigation solutions that leverage data. We believe personalization that leads to behavior change starts with data and a deep understanding of just how different users are.

We believe price transparency provides a critical first step on the journey to getting employees to the right provider. However, these additional strategies leverage transparency to more effectively intercept and guide employees to the right care, from the right provider, at the right time.

For reprint and licensing requests for this article, click here.