Coalition Seeks To Improve Health Care Cost Data Transparency

April 10, 2015 in News

A coalition of consumer advocacy organizations, drugmakers, insurers and providers has launched “Clear Choices,” a new initiative to push for more cost transparency in health care, Kaiser Health News reports.

Members of the coalition include:

  • AARP;
  • Aetna;
  • The American Academy of Family Physicians;
  • The Ambulatory Surgery Center Association;
  • The National Consumers League;
  • The National Council for Behavioral Health; and
  • Novo Nordisk.

Goals

The group aims to promote increased transparency of health care information, including claims data, quality metrics and lists of in-network providers and covered prescriptions.

According to KHN, the coalition’s initial priority is to secure the passage of the plan (HR 2) to permanently replace Medicare’s sustainable growth rate formula (Gillespie, Kaiser Health News, 4/9). The legislation includes a provision to allow academics to analyze certain federal claims data to help determine which treatments are best for particular patients. The coalition said, “Freeing that data could empower us to save trillions and improve care” (Howell, Washington Times, 4/9).

Other goals of the initiative include:

  • Improving quality metrics and ensuring patients have access to such data;
  • Requiring hospitals to provide more clarity about what is included in their cost estimates of particular procedures;
  • Launching better consumer tools for individuals to compare prices, safety and quality of care among providers (Kaiser Health News, 4/9); and
  • Improving how the ACA’s insurance exchanges detail the provider and medication lists of certain health plans (Washington Times, 4/9).

The group’s “most lofty goal” is to allow consumers to know the cost of particular procedures up front, according to KHN (Kaiser Health News, 4/9).

Reaction

HHS on Thursday said that it already is taking steps to make it easier for exchange users to compare plans, including by provider lists (Washington Times, 4/9).

Meanwhile, some observers said it would be difficult for patients to be able to know the cost of a procedure before receiving care.

Mark Pauly, a professor of health care management at the University of Pennsylvania, said, “It’s like asking what the price [will be] for the repair of a leaky roof before the roofer has figured out the cause of the leak,” adding, “It’s harder for the insurer to tell you what you will end up paying until you have precise information on what services you will be using — which patients (and, for that matter, doctors) do not always know in advance” (Kaiser Health News, 4/9).

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