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Navigating the new consumer journey: Regulatory shifts to track

One aspect of healthcare that will remain constant is that very little remains constant. Within this ever-changing environment, it has become clear that the consumer (patient) experience is overdue for a refresh. While in the past healthcare hasn’t focused on flexibility or personalization, these qualities are becoming a standard expectation as consumers continue using everyday technology to make their lives more convenient and their interactions across various industries more seamless.

Several recent regulatory changes are now pushing healthcare organizations to offer the same consumer experiences often delivered by other industries.

Price Transparency

You wouldn’t buy a car without knowing the cost, nor would you go to a restaurant and order from a menu with no prices. And yet, patients often select care or seek specific medical services without knowing exactly what the total cost will be or what they are responsible for paying. As a result, unexpected healthcare expenses are a significant source of financial challenge in this country, leading to thousands of bankruptcy cases every year.

To address this issue, the Centers for Medicare & Medicaid Services (CMS) developed the Hospital Price Transparency rule, which went into effect Jan. 1, 2021. This regulation requires hospitals to publish a machine-readable file of their standard charges for items and services, as well as a consumer-friendly list of 300 “shoppable services,” or those offered in non-urgent cases. While the regulation was drafted by the Trump Administration, this is an issue with bipartisan commitment to address it, and the Biden Administration proposed just weeks ago a significant increase in the penalties for hospitals that do not comply with the requirements.

The price transparency rule does not require hospitals to share how much consumers will pay out of pocket, but there is a partner rule from CMS titled Transparency in Coverage which requires insurers and payers to publish out-of-pocket costs to their members as of Jan. 1, 2022, which will enable patients to more effectively compare not only the total cost of a procedure or diagnostic test but the hit to their wallet. With greater visibility into cost and increased ability to move patient data from one care provider to another, consumers can start “shopping” for care that meets their clinical and financial needs.

Another good step has been taken recently with the offering of Veradigm’s RxTruePrice™ solution, which helps patients gain better visibility into prescription prices at the point of care. The solution provides patients with knowledge on generic alternatives, coupons, vendor-sponsored patient financial assistance programs and price with (and without) insurance at local pharmacies. While there is work to be done on delivering full price transparency for all medical procedures, the beginnings of the path forward have been established.

21st Century Cures Act

Competition across the healthcare industry is a good thing. It drives innovation, which helps improve overall patient care and clinician well-being. However, when competition for patients comes at the expense of the consumer and their optimal outcomes, it becomes an issue that must be addressed.

This notion is written into the 21st Century Cures Act. Effective Apr. 5, 2021, the information-blocking rule of the Cures Act stands up a strong set of industry-wide requirements to discourage providers, health IT developers and other stakeholders from impeding competitors’ access to and exchange of electronic health information. In addition to pushing the industry forward by requiring enhanced interoperability functionality of health IT solutions, including API standards to ease third-party applications in extracting patient data, the rule helps ensure patients’ medical history follows them as they move throughout the healthcare ecosystem.

As a result, consumers will soon be able to easily manage comprehensive health data just as they would manage personal finances, travel arrangements or concert tickets: from their everyday mobile devices.

These two elements of the Cures Act, combined with technology advancements, are ushering in a new era of connectivity and patient engagement. For example, diabetic patients can more easily manage their health between appointments by leveraging Bluetooth-enabled glucometers that feed data into the EHR. Smart watches can collect data on sleeping patterns for those with apnea with little effort on the part of the user. Mobile apps like FollowMyHealth® enable patients to connect with providers across a community, in real time and asynchronously, from their tablets and smartphones. EHR integrations with consumer-facing apps and connected devices fit healthcare into consumers’ lives—not the other way around.

Looking Ahead

Regulations alone will never solve healthcare’s biggest challenges. That’s why Allscripts is committed to building open, connected communities of health. We’re excited by the possibilities as we make that vision a reality for consumers—and those who serve them.

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