With a new year underway, we’re celebrating long-overdue legislative advancements that help protect healthcare consumers and support their ability to make better, more informed decisions about their health and healthcare coverage. By working to prevent unexpected medical bills and requiring greater visibility into the costs of healthcare services, the No Surprises Act (NSA) and the Transparency in Coverage (TiC) Rule enable self-insured employers to better serve their members for the benefit of all.
As a longtime champion of transparency, advocacy and engagement to drive improved member experiences and outcomes, our team at Vālenz® sees exciting possibilities ahead for real transformation in self-insurance. Here are six opportunities for self-insured employers to focus on in 2022:
1. Increase Transparency with Members
Compared with other industries, the lack of insight into costs prior to paying for health services has been unparalleled. The new NSA and TiC legislation ensures cost transparency and finally puts more control in the hands of the healthcare consumer.
Health plan members will now have full visibility into their medical costs and coverage options, so helping them find true clarity is vital. When members receive quality and cost information that’s delivered in a meaningful way, they can recognize the differences, understand what they’re paying for and make the right buying choices. These smarter decisions made by well-informed members are key to the health of the plan as well, keeping costs low and quality high.
Member advocacy is central to this legislation, and it’s a good reminder that the member is central to everything we do. Whether you are a TPA adjudicating claims in making payments, a health system serving its community, or a partner like Valenz offering improved access points to care, navigation and cost savings, the benefits to the member are shared across the board at every step.
2. Improve Collaboration
When it comes to quality, utilization and cost, a lack of alignment among the patient, provider and payer typically results in friction and a diminished experience for everyone. This is where transparency takes the form of better communication and collaboration among all parties.
Provider collaboration helps secure a fair and reasonable reimbursement for high-quality healthcare services. The plan can better identify the goals regarding medical outcomes and alignment of costs, and care navigation helps members traverse a complex system, so they receive the right care at the right place and right time – ensuring the best chance of a positive result. Strong, vigorous and healthy plan members translate to a healthier plan with fewer expenses for everyone involved.
3. Respond to Legislation
Even before the NSA and TiC legislation, a movement was building toward self-funded plans offering improved transparency and cost savings. Slowly but surely, it has become very clear that the average healthcare cost of around $17,000 annually per employee – for access to a healthcare system that is difficult to navigate and comprehend, with no consistent measure of quality – is not sustainable for the plan or the member.
These major legislative shifts that occur every 10 years or so – such as HIPAA and the Affordable Care Act – offer a transformative opportunity to change the landscape of healthcare. It’s likely that many members don’t have full understanding of what it means for them. Clear and consistent communication with members must take place to drive the improved outcomes intended by the new legislation.
With the latest changes, we will see much greater visibility into the process of health coverage and service delivery, including data transparency and oversight of how business gets placed to carriers. This shift will create opportunities to examine all options and drive decisions on the best fit for each member’s unique needs.
4. Make Data-Driven Decisions
Data for the sake of data is not useful. It must tell a story that a plan and its members can act upon and understand. Tech-enabled solutions include a tremendous number of data points, but data engagement is what leads the story to fully unfold.
Turning numbers into usable information presented in a clear format can guide employers in the right direction to achieve the best results for their plan members. Data analysis and assessments present the information and actions needed for self-insured employers to unlock greater network potential, predict and save costs, and influence the model of a quality health plan.
5. Embrace Change
The self-insured industry sees shifts every year in the 5-15 percent of claims that drive 70-80 percent of the plan spend – from stop-loss renewals and rate increases to high-dollar COVID-19 claims and new therapies. Employers must keep up with the changes and fluctuations in the types of claims that drive their greatest spending and act accordingly.
As information from the clinical arm of the business (medical intelligence) coalesces with the data/technology side (tying to the claim, provider and payment), it’s possible to pinpoint that 5-15 percent in real time. Doing so provides insight into actionable steps to identify it and solve it quickly and proactively.
6. Create an Agile, Respectful Culture
The healthcare industry is evolving at a breakneck pace, accelerating through legislation and a call for change. This results in myriad healthcare management decisions new to many employer groups, including those that self-insure. A plan’s success in serving members hinges on the ability to predict and proactively manage the needs of the unique population and every individual within.
At Valenz, we have built an agile culture where we know how to be comfortable being uncomfortable. As we work to simplify the complexities of healthcare, we are not afraid to take chances that go beyond traditional norms. That’s how we grow as an organization and how we offer unique value to our partners.
We believe a culture of inclusivity and agility is the right way to address improvements to the system our members navigate. The Valenz culture is also about how we work together and how we treat the people who work with us. If you are partnering with an enterprise to help you make benefit and coverage decisions, you need to understand how they operate and know if they live out the values required for meaningful, positive and all-encompassing change.
Partnerships must be respectful and collaborative enough to refrain from a quick negative response and, in its place, say “Yes, and…” instead. That positions us to capitalize on shared resources and data, so we can uncover new solutions together. When we listen without judgment, build upon each other’s expertise, redirect when necessary and get it right together, that’s how we create healthier plans and ensure that members will be strong, vigorous and healthy in 2022 and beyond.
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Rob Gelb is Chief Executive Officer of Vālenz®, the industry-leading ecosystem offering self-insured employers unrivaled data transparency to pinpoint members at highest risk, address gaps in network designs, ensure appropriate and accurate charges, and expertly navigate members to optimal care solutions for substantial cost savings and improved health outcomes.
