The Essential Elements of Transparent Open Networks

We know that the pricing system as it stands in the United States healthcare industry isn’t working.

Costs continue to skyrocket, and administrative costs and provider fees are a big part of why.

How can you as a business leader rein it in and make sure you know what you’re actually paying for?

Captiva Benefit Solutions answers that question by following the Transparent Open Network model, a key component of the Health Rosetta’s approach to revolutionizing how we think about healthcare. 

If you’re ready to stop paying the overhead, read on to discover the essential elements of what that kind of network entails.  

 

1. Transparency

That this would rank first on the list probably comes as no surprise. Transparency means that you know exactly what you’re paying for — and also that you know that what you’re paying is a fair price. One tool for achieving this is reference-based pricing. 

Earlier this year, CNBC reported: “Over the past nine years, employee out-of-pocket spending for a family of four increased 69 percent in the form of higher co-pays and higher deductibles, along with 105 percent employee premium contribution growth. Over the same period, employer premium contributions increased 62 percent.”

It’s clear that a lack of transparency is costing both employers and employees. With networks that lay out the facts, it doesn’t need to weigh down your spending any longer.

 

2. Bundled Payments

Bundled payments are the answer to one of the broken ways that costs of care are usually decided on. Most of the time, doctors charge per service performed in a given visit, allowing them to stack up fees and encouraging them to add unnecessary procedures.

Bundled payments push back against this fee-for-service model by setting one payment for an entire episode of care.

This model was actually encouraged by the Affordable Care Act. Some of the early health providers who have started using the model have already seen savings. Plus, getting just one bill cuts out both patient confusion and more administrative overhead.

 

3. Shared Risk

As we mentioned above, the fee-for-service method often means that health practitioners are encouraged to push for quantity above quality.

Shared risk basically requires providers to take responsibility for mistakes or complications within a certain window after the initial care was delivered.

The shared risk model is one that has already been present on some level in Medicare for years, and has been proposed for expansion. But under Transparent Open Networks, the model is brought into the private sector (and potentially your business) as well.

 

4. Efficient Administration

We’ve established that bureaucracy and unnecessary administrative middle men are a big part of the bleed on healthcare overspending.

One of the most important ways to make healthcare work for you is to create speed and efficiency. This can be done by streamlining the payment process, eliminating copay systems and paying providers directly and quickly. That’s a lot for an employer to handle without a big name insurance provider, which is why Captiva is here to help you.

 

5. Employee Education

Transparency need to go beyond the employer relationship with health care prices and providers; it needs to reach the employee level. One survey showed that as many as half of employees were confused and stressed by the health insurance options presented to them. Big words and confusing deductible structures can leave employees choosing options that aren’t even what they think they’re choosing.

Caring for your employees well means providing consistent, clear education on how a Transparent Open Network functions, empowering them to understand their choices.

 

6. Ease of Use

This final key element sums up all of the others: we believe healthcare should be easier to use, for employers, for their employees, for healthcare providers.

Easy access to appointments and quality care without paperwork headache greatly improves an employee’s quality of life. Less time wasted negotiating with opaque health insurance providers means more time helping your business thrive.

 

If you’re ready for an honest way to do healthcare, Captiva is ready to begin a substantive discussion about how to revolutionize the way you provide for your employees.

The following post The Essential Elements of Transparent Open Networks is courtesy of: Captiva Benefit Solutions Health Benefits