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The hospital price transparency rule requires all hospitals to publish payer-negotiated rates for their 300 shoppable services. A thorough interpretation of the list of required services is imperative.
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Know More, Pay Less Price Transparency Healthcare consumerism has been on the rise for the past few years, because of increasing out-of-pocket costs to individual patients. Consumers are feeling the pinch with this shift in risk burden through consumer driven health plans with higher deductibles and/or co-pays. As a result, they expect more payment transparency from providers and payers. In 2019, 51% of the workforce was enrolled in a high deductible health plan – a 43% increase over the past five years. This is one of the most significant healthcare trends – now amounting to 30%+ out-of-pocket expenses for the patient. So, it is not surprising that patients expect transparent and clear information about their healthcare bills. An executive order, “Improving Price and Quality Transparency in American Healthcare,” was passed in 2019 allowing the Centers for Medicare & Medicaid Services (CMS) for providers to publish payer-negotiated rates for 300+ shoppable services. This information is expected to be beneficial to consumers, as they can estimate their co-pay for certain services. RightPx Solution Our iOS and Android RightPx app helps consumers shop for the lowest price for a service along with quality ratings. With RightPx: • Save money by comparing prices for 500+ shoppable services • Choose high-quality providers based on their rating • Select the best facility at the lowest cost for a procedure • Make informed decisions Empowering patients with the information they need so they can make decisions based on cost and quality, will make health care system evolve to one that competes for patients. Lack of price transparency has resulted in a system that denies a patient the ability to make value-based health decisions centered on out-of-pocket costs. Integrating quality and price information helps patients make the right decision for their health.
Value Proposition We create solutions that we would want for ourselves, one that would help us get the best possible care at an affordable rate. Patients • Save money by comparing costs and quality for the same procedure across multiple hospitals • Find providers whose practice patterns are suited for one’s own individual needs Providers • Increase market share • Gain recognition as an innovative transparent provider with a Zigna Transparency seal • Become a trusted advisor physician to the patient as they embark on their care pathway Self-insured Employers & Brokers • Shared cost savings • Compare carriers pricing by facility to select lowest cost network without compromising on quality Payers • Shared cost savings • Gain insights into reimbursement levels compared to peers by procedure, case-mix, line of business and market to inform key decisions around contract negotiations, network design and adequacy Why RightPx? Make informed decisions through trusted data and technology • Access HIPAA compliant, curated, and transparent data for 3500+ hospitals • Filter your results with key words and different search narrowing capabilities such as city, state, distance, provider ratings, and price • Integrate data into your existing systems with an API connection • Data discovery environment to create custom cohorts for deep-dive analysis, analyze trends against a national benchmark • Rigorous QC, and methodology documentation ZignaAI empowers payers, providers and patients with AI-powered software solutions that drive transparency in healthcare payment services. We believe that every American deserves transparent pricing to healthcare that fits their lifestyle and needs. Powered by our human-enabled AI platform, we have built a suite of solutions that are laser-focused on minimizing healthcare costs and enabling payment transparency, whether it’s between a patient and a provider or a provider and a payer. Built-in intelligence enabled machine learning algorithms deliver pre-billing payment accuracy solutions and avoid provider abrasion. ZignaAI’s innovative and scalable solutions cover Medicaid, Medicare and Commercial policies and deliver results in weeks. Contact us at info@zignaai.com to learn more. info@zignaai.com | www.zignaai.com
