The path from transparency to transformation in health care

By Philip Kaufman, Chief Operations Officer, UnitedHealthcare Employer & Individual

When we look back on the last two years, I believe that the pandemic combined with new transparency regulations in the Transparency in Coverage Rule and Consolidated Appropriations Act set the stage for more radical changes than the previous 20 years combined.

Why in theory is transparency such a powerful force? Consumers, with access to data from hospitals and health plans that they haven’t seen before, may make better choices, and drive cost and quality advantages through the entire health ecosystem.

We’ve long recognized the importance of transparency and provided tools to help our members understand their costs. For example, UnitedHealthcare members accessed more than $10.9 billion in cost estimates in 2019 for more than 820 common medical services.¹ 

But what needs to happen to move from transparency to transformation? Here’s what I think:

It starts with consumer engagement, led by digital tools

There are no benefits of transparency if no one ever bothers to look at the price in the first place. We can provide the UnitedHealthcare® app and member portal tools to help our members navigate their benefits, including up-to-date provider directories and treatment cost estimates for providers at specific locations. But we can’t just build tools like this and expect our members will come. We also focus on creating easier navigation paths and compelling content to encourage members to engage with our digital assets.

One way we’re doing this is by reaching members through collaborations with digital fitness companies like Peloton. By listening to what excites our members in their daily lives and anticipating future health care needs, we can build more trust and a better personalized experience for our members — becoming a source in managing their health and wellness. For instance, when a member comes to our website or app for fitness, we’re able to add a prompt to check out our new cost transparency tool for an upcoming knee surgery.

Creating a true consumer experience in health care

Once we have members engaged, their experience should match what they expect from shopping outside of health care. We want to give them a reason to keep coming back.

Today, it’s common to research online for the price of a new car, TV or home before you buy it, and this has made countless purchase decisions more informed and transparent. One major reason efforts at health care transparency have struggled is medical coding – the way in which clinicians bill insurers and how prices will be shown in the market. It’s a bear (a big one, like a grizzly). Imagine going car shopping online and being forced to separately identify and price every component from the engine to the taillights.

In health care, that is relatively common. For a typical knee surgery, a consumer has three sets of cost codes (facility charge, surgical fee and anesthesiology), which doesn’t even count the imaging prior, any complications that may emerge during the operation itself and any physical rehab required after.

Here’s the good news – our cost estimators can show how much members are likely to pay for common health care treatments (all those codes above bundled for a logical service). The Transparency in Coverage Rule has further defined 500 items and services for 2023, and then all items and services by 2024. This will help bring more real-time clarity to how health care choices impact costs in the short and long term.

Looking ahead, when consumers face more complex medical situations, such as managing chronic health conditions or preparing for upcoming surgeries, my hope is that transparency provided by online tools can become an important consumer data point not just in terms of the price tag, but the relative efficacy versus other potential treatment options.

When members make informed choices, they should be rewarded

To review, we’ve convinced members to engage and they can logically understand the price and quality of a procedure. What’s the last piece? When members make more informed choices, we want them to be rewarded. For example, UnitedHealthcare offers a number of programs that offer cash incentives or lower copays when using a UnitedHealth Premium^® Care Physician.  And we want the most efficient, highest quality clinicians to be rewarded for their efforts as well.

Unfortunately, value in health care can be hard to define. Consumers rightly have different notions on how they evaluate medical services and clinicians. And unlike cars, establishing objective measures for outcomes and experience is far more challenging.

While it can’t solve for everything, greater transparency will move the system far closer to alignment on provider cost, quality and experience. Top-performing doctors, hospitals and medical clinics can be rewarded, while other providers have stronger incentives to improve performance. Many anticipate these effects with individual providers will grow, be reinforced and result in broad value-based arrangements between clinicians and insurers across the health system.

With transparency as a key driver, I’m feeling optimistic the consumer experience in health care will continue to improve. At UnitedHealthcare, our attitude is that we cannot afford for it not to.