Reports Highlight Need for Greater Health Care Price Transparency

April 17, 2014 in News

Although New Hampshire is widely seen as a leader in health data transparency, it could do more to boost the use of its consumer price-compare website and make data more easily understandable, according to a report by the California HealthCare Foundation and the Robert Wood Johnson Foundation, Modern Healthcare reports.

CHCF publishes iHealthBeat.

Report Details

For the report — called “Moving Markets: Lessons From New Hampshire’s Health Care Price Transparency Experiment” — researchers interviewed industry stakeholders and experts to gauge state efforts to improve health care price transparency, including the:

  • 2003 launch of an all-payer claims database; and
  • 2007 launch of a public website containing median prices for about 30 common health care procedures.

Report Findings

The report noted that traffic to the state’s health care pricing website was low in part because it offered little benefit to the uninsured. The researchers also highlighted the need for meaningful quality data to accompany pricing information (Landen, Modern Healthcare, 4/16).

They wrote, “[W]ithout meaningful quality information, price transparency does not allow purchasers or consumers to assess overall value when choosing providers” (Tu, CHCF/RWJF report, 4/15).

Task Force Calls for Greater Transparency

In related news, a Healthcare Financial Management Association task force on Wednesday released a report urging all members of the health care industry, along with the government and employers, to work collaboratively to ensure that patients have better access to pricing information make more informed decisions about their medical care, Modern Healthcare reports (Modern Healthcare, 4/16).

The task force was made up of consumer advocates and nearly two dozen representatives for providers, insurers, employers and industry lobbying groups.

The problem drew national attention after Time published an article last year by journalist Steven Brill, which highlighted medical billing issues because of differences in pricing nationwide.

HFMA President and CEO Joseph Fifer said, “We need to own this as an industry. We need to step up.”

The report identifies specific stakeholders that should be responsible for providing health services cost information, as well as the type of data that should be conveyed based on a person’s insurance status.

Rich Umbdenstock, president and CEO of the American Hospital Association, acknowledged that stakeholders “couldn’t agree on whose role was what,” adding, “We were using terms differently.”

According to the Washington Post‘s “Wonkblog,” the report is particularly significant because it suggests that providers and payers are recognizing a shift among consumers’ attitudes toward shopping for health care, since many of them are being asked to pay for a greater portion of their care (Millman, “Wonkblog,” Washington Post, 4/16). 

Task Force’s Recommendations

The report’s main recommendations indicate that insurers are responsible for providing their members with information about:

  • The total estimated costs for various services;
  • Patients’ estimated out-of-pocket costs;
  • Whether certain providers are in networks; and
  • Data on outcomes, patient satisfaction and safety scores.

Meanwhile, Medicare and Medicaid are responsible for providing the same sort of pricing information and pricing transparency tools to their beneficiaries, according to the task force.

The report calls on providers to convey such information when treating uninsured individuals or out-of-network patients. It adds that companies should offer health care transparency tools to workers on employer-sponsored plans (Modern Healthcare, 4/16).

However, the report recognized limits to transparency, such as how it might not be beneficial to publicly disclose negotiated rates among care providers, employers and health plans. In such instances, the report detailed alternative methods of achieving transparency, such as disclosing “reference pricing” for self-funding employer plans, which describe how much an employer will cover for a particular service before employees must pay out-of-pocket (“Wonkblog,” Washington Post, 4/16).

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