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Payers Guide to Reducing Complexities (and Costs) in Healthcare

Graphic with text: Payers Guide to Reducing Complexities (and Costs) in Healthcare

Healthcare systems in the U.S. are meant for caring for the people. However, these systems are often complex and not centered wholly around patient experience. 

In fact, according to an Accenture study, healthcare system literacy is falling, meaning more and more patients don't understand things like how to find an in-network versus out-of-network provider, what a prior authorization actually is or even how a deductible or copayment works. These complexities can lead to reduced access to care and worse health outcomes, and they can unnecessarily drive up costs related to medical care and health insurance premiums.

For example, individuals are twice as likely to visit an ER for care for a chronic condition rather than go to a family practitioner for general care if they don't have a good grasp on how their care works. This lack of healthcare literacy leads to as much as $47 billion in medical spend annually across the board. Patients with limited-English proficiency (LEP) can be even more at risk. Some research indicates LEP patients are 24% more likely to visit an ER, not just once but twice for the same condition within as little as 72 hours. The added costs only drive up cost models over time when it comes to health insurance plans and determining standard costs of certain types of care.

Fortunately, healthcare payers are in a position to make critical changes to healthcare systems to improve both cost models and patient experiences by reducing complexities, encouraging better understanding among patients and making sure optimal care improves patient health outcomes. But how can this be achieved? Here are four areas that can be honed to truly make a difference.


1. Simplify

Health insurance plans have become so complex that even something dubbed as "basic" coverage is anything but in the eyes of the average consumer. In order to find fitting coverage, customers have to muddle their way through industry jargon that they often don't understand and can find themselves even more confused when they need to make decisions about how to use the coverage they have when seeking care.

The most innovative, effective health insurance products are more reflective of what the customer understands than organizational processes. Health plans should be simple to understand and use for all consumers — no matter what language they speak. For example, some insurance companies have adopted "on-demand" coverage, which gives people access to coverage as coverage is needed and involves only plan costs as co-pays. These plans have a more simplistic framework with straightforward terms for pricing and picking care providers, so they are easier for everyone to understand and use. 


2. Provide Transparency

For decades, people have grown to expect the unexpected with healthcare costs, even with insurance. People often seek care without a clue as to what the final bill will be because of a lack of understanding of either their healthcare plan or even how much a certain visit or procedure will cost. 

Instead of a black box of unwelcome cost surprises, customers should have access to an actual shopping experience. They should be presented with clear options and their associated out-of-pocket costs. Payers have the opportunity to make this possible, especially with the latest price transparency guidelines in healthcare. With transparent pricing models, your customers will know what to expect and can make more informed decisions about their care. 


3. Collaborate

Payers must collaborate with providers in order to cut through healthcare complexities. Otherwise, payers are at the mercy of providers because providers typically control the costs associated with care. When you have your finger on the pulse of provider pricing models, you can give clear and consistent guidance to customers about various levels of care of specific care providers. In turn, the patient gets to make a more informed and economical decision. 


4. Reimagine

Reimagine everything from customer service and digital guidance to how you provide information through design. Look at each of these elements from the perspective of the people you serve. Likewise, all changes made within how you function should be human-centered, including products, workflow and more. Sometimes, systemic changes will be necessary to truly create a human-centered service experience. For example, instead of applying fixes to an open enrollment process to target certain problems, pick the process apart and rebuild it so open enrollment is accessible to every individual in the same simplistic way. 


Humanizing Healthcare Changes Everything

At the end of the day, more complicated processes in healthcare and insurance lead to more administrative interaction and costs and a higher burden of cost among patients. By using a more human-centered approach to providing services as a payer, your members gain the ability to make the best decisions about their care and how they spend their money to stay well. 

Offering language support is one way of taking a more human-centered approach in your organization. Request a demo to find out how GLOBO helps healthcare payers communicate seamlessly with multilingual consumers. 


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