what do you think it would take for health plans to provide access to claims reports? why isn't this the norm? do we need a claims "transparency" movement to mirror what's happened with prices?
1) their systems are not really designed to share claims in a great way - they slowly come around for VBC contracts, but unless there is a benefit for them they won't invest into the necessary IT.
2) sharing claims data can actually hurting their business - if they give the claims to their employers they can use that data to shop around with other carriers (assuming 50+ employees). If they don't have that data, the new carriers have to rely on incomplete information and might not want to underwrite the group.
what do you think it would take for health plans to provide access to claims reports? why isn't this the norm? do we need a claims "transparency" movement to mirror what's happened with prices?
Great question! I think there are two reasons:
1) their systems are not really designed to share claims in a great way - they slowly come around for VBC contracts, but unless there is a benefit for them they won't invest into the necessary IT.
2) sharing claims data can actually hurting their business - if they give the claims to their employers they can use that data to shop around with other carriers (assuming 50+ employees). If they don't have that data, the new carriers have to rely on incomplete information and might not want to underwrite the group.