For many Americans, the hardest part of paying for healthcare isn’t always the bill. It’s what happens before the bill arrives – when someone is asked to make a decision before they know how it will land in their wallet. In our healthcare system today, we talk constantly about the cost of care. We debate prices, networks and more, but we talk less about the experience of not knowing – that paralyzing uncertainty that sits between an individual’s need for care and their decision to seek care. More than one-third of U.S. adults say they have postponed or skipped needed medical care because of cost. While high prices and underlying cost drivers remain critical challenges, I’d argue this doesn’t just reflect price, it reflects a system that lacks reliable, timely information about what care will actually cost.
When the healthcare system defaults to uncertainty, people delay care because it feels safer for their wallets. In some cases, people wait too long, leaving an ER visit as the path of least resistance.
This is a problem that requires a different solution, one that helps ensure needed care doesn’t become unnecessarily costly. If lowering the cost of care is about helping people get the right help at the right time, then predictability must be part of the solution, not an afterthought.
When uncertainty becomes a barrier to care
Uncertainty isn’t just a small inconvenience. Patients fear the financial impact of seeking care. If someone can’t estimate what they’ll owe, they’re more likely to postpone a test, stretch a prescription or even skip a follow up visit entirely, making it impossible for clinicians to close care gaps in real time. Even when coverage details do exist, they’re oftentimes inaccessible when a decision has to be made.
While price transparency efforts have made important progress, they can still fall short in practice. The system has moved in the right direction but while it has delivered information that technically exists, like a listed price or estimate, that information doesn’t practically help. An extensive list of billing codes doesn’t answer the questions someone has the night before an appointment. Knowing whether a physician is ‘in network’ doesn’t prepare someone to know the financial impact of any recommended test or medication.
What people need isn’t more data. It’s clarity at the moment of decision based on what their plan covers for their specific situation, what they’re likely to pay, and whether a better option exists.
How this impacts cost
One of the clearest examples of how predictability impacts cost is where care is delivered. Many procedures like infusions, imaging and follow-up cancer treatment can be performed safely in more than one setting. A hospital outpatient department and a physician’s office can provide the same clinical care, but the cost can vary drastically. For people managing conditions such as cancer treatment, the site of care can mean differences of hundreds or thousands of dollars out of pocket – a fact many don’t learn until after the bill arrives.
A patient doesn’t need a master’s degree in business administration to benefit from this information. They need a simple summary that clearly articulates the clinically appropriate options, what each option is likely to cost and how to choose without being surprised. When this guidance exists, people can easily use in-network providers, follow through on care in a timely manner and stay in lower-cost settings when clinically appropriate that may be available when the tradeoffs are explained clearly.
These choices can add up, positively, for benefits providers and employers. Addressing those gaps earlier can help reduce ER visits, support earlier diagnoses, and contribute to lowering the total cost of care for patients, bending the curve in the right direction. It’s not only because prices change – it’s also due to people having the information they need to make the right choices.
Acting on predictability
Here is one thing that we can say for certain: the right information almost never reaches patients when they need it. We need to design the system deliberately to make this happen, and it can’t just be bolted above the “exit” sign.
This means rethinking where and when members encounter cost and coverage information. It means ensuring that digital tools can more clearly guide decisions, such as whether someone should go to the ER at midnight. It includes leveraging navigation to help guide people to the right appointment and is scheduled before the claim is processed. And it’s measurable. We can identify patterns in where people fall off, where scheduling is abandoned, when care goes out of network and when they stop following up.
We can get ahead of the system failing patients and employees by treating predictability as a design requirement, not another added benefit. It’s about making healthcare feel easier to navigate by focusing on the overlooked details: ensuring that information is clear, ready-to-use, and available when decisions need to be made.
From anticipation to delivery
Employers aren’t asking for a different health plan. They’re asking for ways we can reduce the confusion our healthcare system brings for their employees to get the most out of their health plans, without dreading the financial implications. From determining where to go and what specialist to see, to what treatment to take, to when to fit in that follow-up appointment, our job is to help bridge the unknown to the known. We can start by having a clear pathway to answer one simple question: “How much will this cost?”
Lowering the cost of care will always require confronting underlying prices and structural incentives. This work is necessary and it’s ongoing. The system has most of the information. We need to be willing to make it work for the people who need it most.
While predictability may not be the loudest part of healthcare reform, it may be the most actionable. In the end, it is not just about reducing numbers on a bill; it’s about taking a foundational step towards making care manageable for those the system is designed to serve: people in our communities.
Photo: metamorworks, Getty Images
Morgan Kendrick serves as Executive Vice President and President for Elevance Health’s commercial and specialty business with more than 30 years of experience in healthcare. His belief that “all healthcare is local” informs his approach to working with employers, members and communities across the country.
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