Price Transparency: Competing for Patients in a Cost-Conscious Market

Healthcare’s shift to value-based care has an increasing number of consumers shopping around and asking for pricing of imaging exams before they are scanned. Due to high-deductible health plans (HDHPs) raising out-of-pocket expenses, patients increasingly want insight into their healthcare costs. Advisory Board found that 56% of Americans have tried to obtain their out-of-pocket cost before receiving care. What might be more surprising is that 86% of consumers rated up-front price estimates as having an impact on their decision to use a healthcare provider. Now that hospitals are required by law to post pricing online, price transparency in imaging should be on every director’s radar. Let’s take a look at Advisory Board’s three models for providing imaging price estimates to patients.

Price Transparency: Competing for Patients in a Cost-Conscious Market
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Centralized Model

In the centralized model, the health system provides price estimates for all departments through either a price estimation team or an online tool. Many health systems and hospitals may already have a centralized process in place for providing price estimates to patients. It is important for imaging leaders to be aware of this process and know the details of how price estimates are given, by whom they are given and how often estimates are requested by patients.

Radiology-Led Model

Many imaging departments prefer to provide their own price estimates rather than relying on the centralized hospital estimates. The radiology-led model offers exactly that. Imaging programs train their radiology billing staff or technologists to provide estimates to patients. There are three primary responsibilities for the price estimation staff, and each has key requirements and responsibilities to fulfill the role.

 
#1 Analyze Contracts

Requirements

  • Knowledge of managed care contract structure
  • Understanding of health insurance structure and element

Responsibility

  • Evaluate managed care contracts and estimation process
  • Access database to analyze past quotes

 
#2 Calculate Patient Responsibility

Requirements

  • Experience in identifying and resolving customer issues

Responsibility

  • Calculate patient payment responsibility
  • Utilize analytics and decision-support tools

 
#3 Explain Complex Price Information to Patients

Requirements

  • Interpersonal communications and customer service skills
  • Ability to explain complex financial information in layman terms

Responsibility

  • Communicate price information to patient-facing staff
  • Draft communications directly to patients explaining estimates
  • Provide and explain price estimates to patients

Hub-and-Spoke Model

Lastly, the hub-and-spoke model allows imaging departments and hospitals to share price estimation responsibilities. The price estimation process is handled by a system-wide centralized team supported by the radiology department at certain locations. The hub-and-spoke model combines the benefits of both the centralized and radiology-led models. The imaging team is relieved of the bulk of the price estimation responsibilities and patients are still able to receive estimates directly at key imaging centers.

Every imaging department is different. With varying demand for price estimates from patients and different levels of resources for price estimation services, facilities need to determine which model best fits their specific needs. At a time when many patients find it challenging to pay out-of-pocket for healthcare, it makes sense that they would demand more information to make better decisions for their care and financial goals. Imaging departments must look to implement an appropriate model to provide accurate price estimates to their patients or risk losing them to competitors.