2024 Prediction from François de Brantes, M.S., MBA

We asked our readers and some members of our editorial advisory board to make predictions for 2024. Here's what François de Brantes, M.S., MBA said:

“The combination of the regulatory pressures applied directly to employers and to carriers is going to act like a burst of sunshine on the ugly underbelly of the industry.
At the end of 2023 and through 2024 and beyond, employers have to attest that none of the agreements that they have in place with their intermediaries and consultants (third-party administrators, pharmacy benefit managers, brokers, vendors) contain gag clauses or any other clauses that would prevent employers’ full and unfettered access to all of the information — including claims — they need to prudently manage their health plan. Moreover, all the intermediaries must disclose and justify the fees, commissions and other sources of revenue they derive from their relationship with the employer. The information contained in the hospital and carrier price transparency files will fully reveal the price distortions in each geographic area and the opportunities to help plan members reduce their cost-sharing expenses.

Price shopping is inevitable as a result of the mandate that all payers, and particularly employers, as well as hospitals and health systems, will have to provide plan members with advanced estimates of the total and member-specific prices. Although democratizing the information in the transparency files has proven difficult, it’s far from impossible, and much more precise and user-friendly apps will make their way into the hands of all consumers. That’s going to put a lot of pressure on the hospitals and health systems that have jacked up their prices to several multiples of Medicare rates, without any justification other than they can.

It has been easy to play games with other people’s money when employers have no idea what anything really costs and can’t compare prices. And the carriers have been playing a lot of games at the expense of self-insured employers, negotiating lower prices for their insured lines of business in exchange for higher prices on the networks used by self-insured employers. When employers start either demanding the same rates or go directly to providers, those price advantages will start to shrink and, with that, carrier margins. The same holds true for the excess margins that carriers are realizing by delegating risk to provider entities they control.“