Financial assistance is moving from discretionary policy to regulated infrastructure. For health systems, that shift has significant operational and financial implications.

The post Financial Assistance Reform Is Reshaping Revenue Cycle Strategy appeared first on MedCity News.

Turquoise Health raised $40 million in a Series C round to expand beyond price transparency into managing healthcare contracts. The startup’s platform aims to simplify payer–provider agreements, reduce administrative waste and enable patients to see guaranteed upfront prices.

The post Turquoise Health Snags $40M to Simplify Healthcare Contracts & Payments appeared first on MedCity News.

WTW launched the Health Transparency Optimizer to help employers better understand healthcare costs, quality and network options.

The post WTW Launches Healthcare Pricing Data Solution for Employers appeared first on MedCity News.

[Sponsored] In an interview, UberDoc CEO Sean Kearney described how it is carving a niche for healthcare that better serves patients and physicians.

The post Moving Beyond an Insurance-Based Framework for Healthcare appeared first on MedCity News.

A new Trilliant Health report revealed wide disparities in provider payments, with academic medical centers and certain payer-affiliated clinics receiving far higher reimbursements than their peers for the same services. The findings emphasize just how much opaque pricing practices continue to drive inequities in the U.S. healthcare system.

The post Hospitals & Clinics Still Paid Unequally for Same Care, Research Shows appeared first on MedCity News.

Health care in the United States is confusing for patients and consumers. Price transparency is a step in the right direction — transformative change can happen by combining cost, quality, appropriateness and efficiency measures.

The post Healthcare Price Transparency is Not Enough appeared first on MedCity News.

A new Trilliant Health report reveals vast price variation for identical healthcare services, even for procedures delivered at the exact same facility. Allison Oakes, Trilliant’s chief research officer, urged providers to prove they are delivering true value for the cost and pressed employers to leverage their purchasing power to demand higher-value care.

The post Same Surgery, $220K Apart: Why Providers & Employers Need to Rethink Value Amid Price Disparities appeared first on MedCity News.

As an industry, we can and must do more. To be truly actionable, prices must be easily accessible, understandable, and patients need to be actively engaged to act on that information.

The post Healthcare Price Transparency is More Than Showing a Price Tag appeared first on MedCity News.

For employers to offer effective, accessible and affordable value-based care for their employees, they must address these four components.

The post How Employers Can Leverage Value-Based Care to Drive Retention and Improved Health Outcomes for Employees appeared first on MedCity News.

In the U.S., many people still struggle to find care, book an appointment, confirm coverage, or get a clear answer on pricing. The impact goes beyond inconvenience, contributing to delayed diagnoses, increased anxiety, and financial stress that harms both patients and the healthcare system.

The post The Price is Wrong: We Need to Solve the Healthcare Insurance Transparency Crisis appeared first on MedCity News.

President Donald Trump’s latest executive order aims to strengthen enforcement for CMS’ price transparency requirements. Some experts think greater price transparency could reduce healthcare costs by fostering more competition, while others are concerned about the potential effects on hospital-payer negotiations, as well as the practicality of enforcing these requirements.

The post The Promise and Peril of Price Transparency Under Trump’s New Executive Order appeared first on MedCity News.

Come January 1, CMS will begin enforcing new price transparency requirements for hospitals. Experts doubt that these regulations will do much to help patients shop for care, but they are optimistic that increasing the amount of publicly available pricing data will help tech companies develop tools that simplify pricing for patients.

The post Hospitals Are Facing New Price Transparency Requirements, But Will They Truly Help Patients Shop for Care? appeared first on MedCity News.

[Sponsored] Dan Reedy, senior director of pricing and underwriting for Abarca, spoke recently with MedCity News about what payers should consider as they explore new models and press for greater transparency.

The post Unlocking Transparency in PBM Pricing appeared first on MedCity News.

Elation Health integrated Surescripts’ real-time prescription benefit tool — which gives clinicians immediate access to patient-specific medication coverage and cost data — into its EHR. The partnership aims to improve patients’ medication adherence by helping primary care physicians have more meaningful conversations with their patients about prescription affordability during visits.

The post Elation Health’s New Integration Brings Drug Pricing Transparency to the Point of Care for PCPs appeared first on MedCity News.

Most hospitals and payers have publicly posted their pricing information, but experts think that data will remain mostly useless for consumers for at least another five years. Now that the data is available, healthcare software companies must step in and build tools that are personalized and easy to use. That way, consumers can eventually use price transparency data to shop for care.

The post Despite Price Transparency Laws, Americans Are Nowhere Near Able to Shop for Care. How Can This Change? appeared first on MedCity News.

2024 stands at a critical juncture in the battle against soaring pharmacy costs. In 2023, prescription drug costs rose by 8.4%, a 31% increase from the prior year. Stopping this cost escalation requires restructuring the role of pharmacy benefit managers (PBMs) from multiple fronts. On one front, Congress must pass the proposed legislative reforms that […]

The post 2024: A Pivotal Year in Curbing Pharmacy Costs appeared first on MedCity News.

Turquoise Health closed a $30 million Series B round, which brings its total funding to date to $55 million. The San Diego-based startup, which has more than 160 customers, sells a platform that makes it easier for hospitals and payers to comply with price transparency regulations.

The post Turquoise Health Raises $30M for its Price Transparency Software appeared first on MedCity News.

The word has gained greater urgency in recent years as the consumer trend in healthcare has forced payers, providers and all other kinds of healthcare stakeholders to swear by it.

The post What Was the Most-Repeated Word in CVS Health CEO’s JPM Presentation? appeared first on MedCity News.

Hospitals markedly improved their compliance with price transparency regulations in 2023, according to a new report. It found that more than 90% of hospitals have posted a machine-readable file containing gross charges, negotiated charges and cash prices for the services and items they provide.

The post Hospitals Finally Reached Widespread Price Transparency Compliance in 2023 appeared first on MedCity News.

The mandates set the framework and data requirements for transparency but consumers need more guidance for informed decision-making and comparisons. Health plans should be acting now to turn the conversation from compliance to true member engagement.

The post The Transparency in Coverage Rule Doesn’t Go Far Enough: How to Make the Mandate Meaningful appeared first on MedCity News.

During the first three quarters of 2023, the prices for CMS’ 500 shoppable services increased by 2.0%, according to a new report. This figure is in alignment with the 1.9% U.S. inflation measured by the Personal Consumption Expenditures Price Index and below the overall U.S. inflation rate measured by the Consumer Price Index.

The post Americans’ Healthcare Costs Are Rising With the Pace of Inflation, Report Says appeared first on MedCity News.

The Lower Costs, More Transparency Act has passed in the House with bipartisan support. The action is being applauded from several advocacy organizations.

The post Bipartisan Price Transparency Bill Passes in House appeared first on MedCity News.

Zocdoc Founder and CEO Oliver Kharraz gave five predictions about how patient preferences will evolve in 2024. Some of them include Americans increasingly seeking cash-pay care options and an uptick in patients seeking mental health appointments before and after the presidential election.

The post Zocdoc CEO Predicts 5 Ways Patient Behavior Will Change in 2024 appeared first on MedCity News.

Only actual hospital prices, displayed as dollars and cents, not estimates, formulas, or algorithms, protect patients from outrageous bills and hold hospitals accountable for overcharges, errors, and fraud. Accepting CMS’ or other substitutes instead of actual prices undermines broader efforts to make hospital price transparency a reality for American patients and healthcare consumers.

The post Meaningful Hospital Price Transparency Requires Actual Prices, Not Estimates appeared first on MedCity News.

About 36% of U.S. hospitals are in compliance with CMS’ price transparency rule, up from 24.5% in February, according to a new report. This progress will remain slow unless CMS can do a better job of effectively enforcing its rule, the report declared.

The post Hospitals’ Price Transparency Compliance Is Improving Despite Remaining Low at 36% appeared first on MedCity News.

As of January 1, employer-sponsored Group Health Plans and Health Insurance Issuers must make make the prices of 500 medical services available via an Internet-based tool. The Transparency in Coverage final rule gets even tougher on January 1, 2024, when the prices of all medical services must be made available via an Internet-based tool.

The post Ticking the Talons of Healthcare Transparency appeared first on MedCity News.

Here are the top 10 hidden facts about hospital prices that answer questions about why it is so expensive and why the bills are so complicated.

The post Top 10 Hidden Facts About Hospital Prices appeared first on MedCity News.

Amid the difficult healthcare environment, it’s important to note that there have been some wins for employers, said Katy Spangler, senior advisor of the American Benefits Council, during the Midwest Business Group on Health conference held Tuesday. These wins include the No Surprises Act and price transparency rules.

The post 3 Recent Healthcare Wins for Employers appeared first on MedCity News.

CMS recently fined two hospitals for alleged violations of its price transparency rule. These fines are only the third and fourth penalties issued by the agency since the rule took effect on January 1, 2021. These fines may become more common — CMS also announced that it is updating its enforcement process for the rule.

The post In Rare Move, CMS Fines 2 Hospitals for Price Transparency Violations appeared first on MedCity News.

As a first step to move toward greater hospital price transparency and lower costs, CMS can immediately issue $2 million fines on the 30% of American hospitals it concludes are noncompliant. If CMS takes enforcement seriously, the hospital industry will respond by quickly coming into compliance.

The post Op-Ed: CMS Should Fine 30% of Hospitals It has Found to Be Violating Federal Price Transparency Law appeared first on MedCity News.