Resource Center // Blog // HealthSmart Blog // June 2021

Is Your Plan Ready for Transparency Regulations?

6/30/2021 11:05:36 AM

Is Your Plan Ready for Transparency Regulations?


by Ron Wozny, Vice President of Marketing

Effective January 1, 2022, health plans will be required to post extensive plan pricing data, including cost-sharing details, in and out of network rates, as well as an online consumer pricing tool. Compliance is mandated at the plan level, so self-funded plans will be primarily responsible for compliance. Most plans, however, will rightly expect their TPA partners to support them with compliance.

The Healthcare Price Transparency Rule is rooted in an executive order on healthcare price and quality transparency that was issued in June 2019. The move was part of a larger push to use price transparency to curtail price increases and enable patients to compare the cost of services when making healthcare decisions. On January 1, 2021, the Healthcare Price Transparency Rule became law under the statutory authority of the Patient Protection and Affordable Care Act (ACA). On that date, hospitals and health systems were required to post pricing for hundreds of procedures, with more to come in subsequent years.

Hospitals and health systems have been finding compliance with the law to be a challenge, and so far, enforcement has been lax. With a little more time to prepare, health plans and plan sponsors might hope to be better prepared.

To help plan sponsors prepare to comply with the regulations, HealthSmart has published a white paper. In the white paper, we cover a range of factors that plan sponsors should consider. Learn:
  • What is required of plans by the regulation?
  • What can plan sponsors learn from the experience of hospitals, which have already been required to implement price transparency rules?
  • What effect will transparency have on the cost of health benefits?
  • How can my organization prepare to implement this requirement?
  • How will compliance be enforced?
  • Will transparency be effective as a means of controlling the cost of health benefits over time?
Download the white paper here

We at HealthSmart are committed to making compliance with this new regulation as painless as possible for our clients. Please let us know how we can help you.
About Ron Wozny, Vice President of Marketing
Ron Wozny joined HealthSmart in 2018, bringing more than 20 years’ experience in healthcare marketing. As Vice President of Marketing, he is responsible for developing and executing strategies to increase brand awareness and drive revenue growth. Ron was previously Vice President of Marketing for Healthx, a leading healthcare IT solution provider for member engagement and provider collaboration. He also served as head of marketing for ZeOmega, a leading population health management software provider, and brings strong marketing and healthcare expertise from similar marketing leadership roles at T-System, Beryl Health, Healthvision and VHA (now Vizient).