The next step for consumer price transparency

Last week, the CMS celebrated the anniversary of its Health Tech Ecosystem initiative by rolling out a handful of pledges, promises covering clinical trial matching, scheduling, pharmacy interoperability and other topics.

The one we’re following most closely at Handl Health is the new consumer/medical price transparency pledge. Within six months, pledge signees commit to going live with consumer-facing conversational AI cost estimates, real-time cost-share information, Good Faith Estimates (GFEs) and Advanced Explanations of Benefits (AEOBs) functionality.

We welcome this development. While we’ve been focused on sharing these tools with benefits consultants and brokers on the employer-sponsored side, consumers have been waiting for breakthroughs of their own. GFEs and AEOBs were written into the No Surprises Act back in 2020. The CMS is now putting pressure on health tech companies to translate inscrutable MRFs into something patients can actually use. Consumers should be able to ask any AI tool, in plain language, "How much will this cost me?" and get a real, personalized number before they get care.

While the pledge itself is voluntary, and CMS can’t enforce it, the promise shows the consumer market is trending in the right direction.

What does this all mean in the employer-sponsored universe? Employers aren't the ones signing this pledge, but they are the ones who will feel the pressure indirectly, through their vendor contracts. But they should be very wary of a benefits consultant or a TPA that takes the pledge and shows you a simple AI-connected cost transparency tool; while these tools can be useful in the right context, they have pretty low utilization.

How can employers really make an impact? It’s all about using available data to create a benefit design that uses guaranteed upfront pricing. At Handl, we started in the consumer price transparency space, but have long since moved into variable copay plans to offer that transparency and peace of mind. We're excited to see AEOBs progress so that transparency is given irrespective of plan members choose.

Employers should start asking their benefits consultants and brokers how they are connecting price transparency data to benefit design.

Comment below if you’d like to schedule some time to see how Handl does it.