#WTFix Events Patient Advocacy

Price Transparency Patient Panel: What Health Plan Members Really Want

When it comes to what health plan members want from price transparency—and from their health plan—we believe it’s best to just ask. Earlier this month, as part of our #WTFix campaign, we invited a diverse group of people to share their thoughts on price transparency mandates, health plan digital experiences, and healthcare interactions. The goal with these events is to help health plan leaders understand the needs of their members on a more personal level. They can then take these perspectives into account as they work to address price transparency mandates and build member experiences that empower people to take more control of their healthcare spending. We recommend watching the full panel replay to hear directly from consumers.

HealthSparq has held patient panels before, and as always, the group provided several important insights for plans to consider, chief among them that people just want healthcare to be easier to navigate.

Navigating healthcare is like having a second job

One resounding message that came out of this panel discussion is that healthcare is too challenging to navigate and you have to learn, sometimes at a high cost, by trial and error.

“It’s exhausting,” said Staci, who said it’s a good thing she works from home, because she doesn’t know how someone would deal with all this if they worked out of the house all day long. “You have to constantly be on the phone, gathering up information, keeping tabs on who you’re talking to…it’s like another job.”

Across our panel, we heard again and again that when it comes to navigating healthcare, especially finding providers, understanding coverage, and finding costs, our panelists agreed that accurate information often feels impossible to come by, leaving them frustrated and confused about where to go for answers. “You end up having to be your own advocate,” said Cheryl, who gained experience navigating healthcare by helping her mother.

What can health plans do to help meet the needs of their members? We’ve broken out the three main requests made by our panelists:

1. Create digital experiences that are accurate and easy to navigate
Our panelists all wish they could get more transparency and guidance from their health plan, an online tool would be an important resource for that. Unfortunately, none of our panelists were able to get what they needed from their health plan’s current digital experience. “If you don’t have apps or websites that work, what’s the point in having them?” Asked Jonny.

Panelists felt they often found outdated information online or hit dead ends in their research. What they’d like is more guidance from their health plan about what to do next, or where to go to get what they needed in the context of their health coverage.

Cheryl gave health plans a simple call to action to meet her needs: “just enable the consumer to be able to use your website conveniently and accurately…do you cover this procedure? If not, can you give me some direction about what I can do next. We’re just looking for the information to get done what we need to get done.”

2. Deliver on the promise of price transparency
It was clear that all our panelists want more transparency and guidance when it comes to healthcare costs—especially what they are going to have to pay out-of-pocket for a procedure. Whether they get the information online, over the phone, or through their provider’s office, accuracy about their specific out-of-pocket cost is critical.

“You go to any restaurant and they hand you a menu and the prices are right there…It seems like [doctors] charge what they want, to who they want, when they want. There are no set prices for anything, and I don’t think that’s fair at all. It’s confusing, it’s frustrating, and it’s just not the way it should be,” said Jonny.

3. Develop partnerships with providers to benefit members
Panelists also made it clear they want stronger payer-provider partnership to help make healthcare easier.

“I would like the insurance company or the doctor to tell me ‘this is how much you need to come up with.’ But I don’t get that information; I get all kinds of run arounds. It’s kind of a joke. It’s really difficult to get point blank information on what this procedure is going to cost me,” said Jonny. While David simply asks insurers and providers to “just be up front with what I’m coming into.” He shared that his family doctor will call his insurance company to verify benefits and let him know what’s covered. In David’s ideal world, that treatment would extend to all doctors. He’d love to see more partnership between payers and providers, so he knows what is going to be charged and what’s covered or not through a given provider.

While many of our panelists called out how hard it is to work with insurance to get cost information, Staci pointed out that insurance can be a good thing because it protects members from price gouging. Staci shared that she and her family “hate to go to our hospital because you never know what it’s going to cost. It’s just astronomical what it could be.” She praised insurance in this instance for protecting consumers from price gouging, “insurance won’t just take the cost that the hospital tries to charge when it’s higher than what’s normal.”