Third-Party Organizations
Dealing with insurance on behalf of patients is one of the most basic and core beliefs of the healthcare business. Third-party organizations pay for the insurance expenses covered for an insurance beneficiary. These organizations, which include government insurance like Medicaid and Medicare or private insurance like Blue Cross, are entities that pay medical claims of the insured and reimburse partially or fully the cost of healthcare provider services. There is more demand for transparency from consumers as they pay more for their healthcare.
Third-party organizations stress that inadequacies in healthcare transparency lead to higher care cost and significant patient safety risks. These organizations can address transparency by collecting data about provider companies as driving improvements through transparency creates better care and considerable cost-efficiency. Increased transparency can help ensure that providers are accountable for patient cost and safety (Austin, McGlynn, & Pronovost, 2016). Third-party organizations contribute to increased transparency and patient safety improvement by combining healthcare quality data with cost data. Through sharing cost and quality information simultaneously by a third-party organization, they can aid the consumers to make informed choices and choose the best possible healthcare utilization. Another way of contributing to increased transparency and patient safety improvement entails adopting value-based payments models that focus on provider quality. When designing value-based payment models, the third-party organizations can create health plans that take an active role in promoting data exchange and therefore increase healthcare quality transparency.
The U.S. has the most expensive healthcare system worldwide, as prices are not regulated, and providers can bill whatever amount for their services. Third-party organizations contribute to unnecessary reporting burdens by allowing the consumer to choose the different coverages offered, the physician and place for their medical services. This undue reporting burden raises the cost of medical services without improving quality. Third part organizations through unnecessary reporting might influence a physician’s medical decisions as they are paid by these organizations who also dictate the rules, per their non-negotiable fees. The reporting burden does not do anything to improve the quality of healthcare.