The healthcare financial system is riddled with obstacles that hinder efficiency and drive-up costs, creating additional friction for health plan members who already struggle to navigate a convoluted and confusing healthcare system. The president’s new Executive Order dated February 25, 2025 – Making America Healthy Again by Empowering Patients with Clear, Accurate and Actionable Healthcare Pricing Information (EO) – directing federal agencies to fully implement the healthcare price transparency regulations, highlights that transparency in healthcare pricing is a critical factor in helping members navigate this complexity. When patients have access to clear, accurate and actionable pricing information, they can make better-informed decisions about their care, well before they even step into a provider’s office.
Enabling payers to harness real-time data through a flexible delivery model and differentiating services enhances operational efficiencies and the experience for payers, members, and providers alike.
Payers have the chance to lead the way in embracing innovative technologies to set new standards for support and service, especially before a member receives care. However, to effectively engage with members, payers need access to real-time, secure, and reliable data of the highest confidence. The challenge, of course, is not just in providing data but in making that data useful. The president’s recent EO stresses that data must be actionable, meaning that it should be easy for members to interpret and use in real-time. To transform this data into actionable insights, payers can rely on partnerships that seamlessly integrate with internal systems via API.
Instead of having to manage between disparate vendor tools and digital services, payers can instead rely on one partner who has already integrated valuable ecosystem partners’ data and services. A strong, unified data infrastructure allows payers to provide members with accurate pricing information directly through their platforms—whether it’s through a mobile app, portal, or chatbot. This approach not only aligns with the EO’s emphasis on providing “clear, accurate, and actionable healthcare pricing information” but also allows payers to better equip their members to make informed, cost-conscious healthcare decisions.
Having this wealth of information and services offered in a compliant and organized standard can help health plans bridge the information gap and ensure a seamless, secure and meaningful experience for members.
Removing the friction from your platforms means less time managing member concerns and more time providing quality service. Companies like Zelis add to your capabilities and accelerate development and data management, enabling you to meet plan goals.
Partnerships like this hold immense potential for health plans to transform member interactions across the healthcare system. This really comes to light in the pre-care experience where data and other capabilities provided by an ecosystem partner can support every interaction from empowering enrollment, to activating and guiding members to make the best healthcare decisions they can for their health and their finances.
Payers can pick and choose capabilities they do not have and do not want to build in order to enhance their digital maturity, all tailored to their unique needs and to meet their specific business objectives. Partnerships are a must in order to meet the intent of the regulations and the president’s recent EO – and, more importantly, in order to provide usable, actionable info to patients. This could be by embracing APIs and allowing a partner to integrate seamlessly into their ecosystem, or by leaning on a partner to deliver an intuitive user interface and outstanding user experience augmented by expert human support through custom consulting engagements.
By working with a partner who understands the regulatory and technological landscape, health plans can integrate tools that meet both the Executive Order’s mandate and the evolving needs of their members. This results in a more efficient, cost-effective, and customer-friendly healthcare experience, paving the way for a future where members have greater control and understanding over their healthcare journey.
Looking ahead, Zelis is excited about the potential of what we can deliver for payers to help them achieve their goals and improve care outcomes. I would love to hear from you! In what ways do you think technology partners help bridge gaps for payers while delivering a secure and seamless experience for members?
