Extending the Utility of Price Transparency

Introduction

Price transparency tells the patient what the expected amount is.

That is important, but incomplete. What value is there in presenting a price without also identifying a realistic way to manage it? It is the financial equivalent of recommending a clinical treatment the patient has no practical ability to access.

Economic Intelligence connects the disclosed amount to the patient's financial condition and identifies a viable path forward. This essay therefore addresses two related questions: How can the patient navigate and economically act on the disclosed price, and can the resulting financial clarity move with the patient into the healthcare transaction?

The Two Market-Utility Gaps

An accurate estimate can still leave both questions unanswered.

The first gap is between price visibility and purchase viability. The disclosed amount does not establish whether the patient can realistically proceed, what assistance may apply, or what payment structure could make care attainable.

The second gap is between financial clarity and commerce execution. Even when the viable path is understood, healthcare often separates the estimate from scheduling, coverage, assistance, payment, and financing.

These gaps are related but distinct. Transparency creates visibility, but visibility alone does not complete the patient's economic purchase decision—a limitation reflected in the low utilization and limited spending impact of price-transparency tools when information is merely made available. [1]

Closing the First Gap: From Price Visibility to Purchase Viability

Closing the first gap requires more than a precise estimate. It requires evaluating patient capacity, coverage, assistance, liquidity, payment structure, and expected provider value to determine whether the obligation should remain as presented or move to a more viable path.

The foundation already exists in today's estimates and transparency tools. Economic Intelligence would extend those systems through an interactive financial evaluation. After receiving the price, the patient would provide a limited set of information—similar to a standard financial-counseling interaction, but well short of a full financial disclosure or assistance application. Transparent to the patient and aligned with the health system's policies, the process could assess household size and income range, coverage, major obligations, liquidity stress, monthly payment capacity, and potential assistance eligibility.

That information would create a concise needs profile supporting a high-confidence determination of the most viable path. Much like financial prequalification in other markets, it would identify likely fit and available options before requiring a full application or committing the patient to a particular course.

Closing the Second Gap: From Financial Clarity to Commerce Execution

Closing the second gap requires carrying that financial determination into the transaction itself.

In conventional digital commerce, product selection, price, qualification, available options, and payment are connected. Healthcare usually separates them, requiring patients to move through disconnected estimating, assistance, financing, payment, and scheduling workflows.

A more complete model would allow the selected financial path—and the information supporting it—to travel with the patient into the appropriate workflow, reducing repetition, supporting documentation, and preserving the decision as care moves forward.

For shoppable services, the opportunity depends on the procedure. Some may be initiated directly by the patient; others require a physician order or prior clinical determination. In those cases, the clinical need is not being shopped. The patient is evaluating where, when, and under what financial terms the prescribed service will be delivered.

ARxChange's Healthcare Commerce Network—developed with support from Mastercard and AWS—illustrates this model by integrating provider search, price visibility, Economic Intelligence, personalized financial options, scheduling, and transaction support where care is selected. It reflects the broader market direction to "re-assemble the industry around the consumer" by connecting functions that have historically operated separately. [2]

Market-Forward: From Disclosure to Commerce

By converting the disclosed amount into a viable financial decision—and embedding that decision directly into the commerce and transaction experience—Economic Intelligence creates a more complete consumer journey, reduces downstream revenue-cycle cost and friction, accelerates resolution, and enables the financial process to function more like modern e-commerce: personalized, integrated, and carried forward without requiring the patient or provider to begin again at each step.

References

1. Desai et al. found that offering a price-transparency tool was not associated with lower healthcare spending. Whaley et al. found that offering a transparency tool did not reduce overall spending on shoppable services and reported limited employee utilization. Sinaiko and Rosenthal similarly identified limited evidence regarding how patients use transparency tools and the degree to which those tools affect healthcare choices.
2. ARxChange, Healthcare Commerce Network, developed with support from Mastercard and AWS. See also Mastercard, "The Secret to More Affordable Health Care: Price Transparency and Flexibility," February 3, 2022, which describes the Healthcare Commerce Network as combining ARxChange analytics and adaptive financial-assistance capabilities with Mastercard billing and payment capabilities to personalize price and payment options based on patient affordability. Deloitte's Point of View on the ARxChange Healthcare Commerce Network: Industry Leadership Discussion on Consumerism, sponsored by Koch, similarly characterizes the model as reassembling healthcare around the consumer by connecting transparency, personalized payment options, choice, access, and provider value.