Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

Healthcare Consumers Demand More Coverage Comparison Options

"The future for CMS is to create an open-source environment that drives innovation for the consumer."

By Jacqueline DiChiara

- A new pilot initiative involving a “Doctor Lookup” feature is now available for some healthcare consumers’ online perusal. Such a beta feature lets healthcare consumers compare coverage options in association with their individual preferences on health facilities or providers.

healthcare transparency Doctor Lookup

Nearly twenty-five percent of randomly selected visitors will have access to this online feature, says a recent press release from the Centers for Medicare & Medicaid Services (CMS).

Says Kevin Counihan, CEO of the Health Insurance Marketplace, this feature is merely a response to consumer demand.

A pilot approach, says CMS, allows the organization to more closely examine consumer experience needs via quality data analysis and feedback.

The goal of “Doctor Lookup” is to provide healthcare consumers with accurate, appropriate, and personalized information about their plan prior to their enrollment, says Counihan.

"The future for CMS is to create an open-source environment that drives innovation for the consumer. By requiring data transparency from health plans and providers and by releasing the information in a machine readable format, we are using consumer demand to accelerate that change," says CMS Acting Administrator, Andy Slavitt.

“Doctor Lookup” feature is problematic, says CMS

Online healthcare information is not always accurate. Says CMS, healthcare plan information changes frequently and is not always updated with expediency.

Such can naturally prove problematic. Healthcare consumers often face confusion when they rely on outdated information.

Said Berkeley Research Group (BRG) to regarding burdens of inaccurate provider directors and subsequent litigation consequences, “Given an environment that is increasingly regulatory, litigious, investigative, and putative, health plans should deploy organizational resources at a level that is commensurate with the level of risk that these inaccuracies can present.”

Echoing this idea, CMS says there are indeed tangible limitations to information inaccuracies. CMS says consumers will be made aware of such limitations via an “opt-in” feature. Whether or not this “opt-in” feature will actually be read by the majority of those who click upon it while researching their healthcare coverage information is not quite clear.

CMS confirms alleged data loopholes with the “Doctor Lookup” feature – such as missing or inaccurate information – may require future tweaks to be truly advantageous to healthcare consumers.

“[We are] encouraging consumers to check with their doctor or plan to confirm that the doctor accepts that plan,” CMS states.

Efforts are underway to ensure information accuracy. Says CMS, “ has access to data from over 90 percent of insurance companies on the Marketplace. If an insurance company has not provided validated data, consumers will be alerted when they search for a provider that there is ‘no data from insurance company.’”

CMS says insurers are mandated to provide accurate information about which doctors and facilities are in their networks. Plans must also provide information about medication coverage. Prescription drug information may be available shortly, CMS says.

Are healthcare consumers really shopping around?

Although healthcare consumers tend to be unaware of transparency, they actively yearn for more information, as reported.

The most common way healthcare consumers acquire information is reportedly the old fashioned way: through family, friends, and general word of mouth. The second most common means of acquiring consumer information is reportedly via a medical office staff, such as a receptionist.

Contradictory to CMS’s views, other research confirms healthcare consumers are not always keen to online comparison shopping. They are, however, willing to research, albeit perhaps more narrowly. Although more than half of Americans have attempted to look up price information before receiving care, less than a quarter reportedly checked more than one price.


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