It’s no secret that health care consumers are challenged today to make informed decisions without understandable and complete information about the prices of services and recommended therapies, or information about quality and outcomes. And it’s also no secret that legislators and regulators in both federal and state governments are starting to recognize the importance of improving cost and quality transparency with consumers, as evidenced by CMS’ Blue Button 2.0 initiative, and the continued growth of All Payer Claims Databases in the states.
There have been a lot of health policy and regulatory conversations this year around the topics of price and cost transparency, encompassing everything from the cost of a physician office visit to the real costs of pharmaceuticals. But what does “price transparency” really mean in health care? Most consumers are primarily concerned with what their out-of-pocket amounts are, particularly if they are in a high deductible health plan or uninsured. Complete price information can be complicated because of many factors, including the geographic or facility location where a health care service is provided, the type of insurance coverage (if any) a patient has, and the schedule of covered benefits for those who are insured.
Health care consumers can’t make informed decisions unless all stakeholders become more transparent about the costs and quality of health care services and therapies, including pharmaceuticals, durable medical equipment, and devices. While cost and quality data is largely available, the format in which it is delivered to consumers often makes such informed decisions difficult. This is where a new generation of health IT-enabled solutions, combined with educational and financial services resources, can make a real impact.
Today, most costs incurred are not realized by the patient until well after a health care service or visit occurs, and it can be three to six weeks until a bill arrives. In many cases where costs exceed a consumer’s ability or willingness to pay, providers can experience either late payment or no payment at all. In our experience, only the most motivated patients will look for existing cost estimation tools on a health insurer portal, or from a health system call center. Even when portals and call centers exist, it’s frequently up to the consumer to research the relevant information about a procedure or treatment, yielding a time-consuming and frustrating effort. In addition, we have found that a leading cause of appointment no-shows is because consumers are uncertain of the final costs.
As my colleague, Kris Joshi, discussed in Becker’s Hospital Review earlier this year, a neutral information infrastructure centered on the patient with information that’s easily accessible will help make patients more informed decision-makers when it comes to their own care. It will also further enhance the clinician-patient relationship and dialogue. With prior knowledge of the exact out-of-pocket costs, consumers can begin to make financial and/or treatment choices prior to a health care procedure. Imagine a user-friendly and accessible application — much like the True View solution from Change Healthcare — which provides:
- An up-to-date provider directory combined with cost information for more than 1,000 medical procedures based on plan, network, and location;
- Cost and quality benchmarks generated from data from 92 percent of the top 25 health plans; and
- Customized health education information, all at a consumer’s fingertips on a mobile device.
This same solution could also provide links and referrals to a variety of trusted service companies, including an option to help set up a payment plan with a provider.
But price and quality transparency isn’t just important to consumers. We also recognize the need for greater trust and collaboration across all stakeholder groups in exchanging and sharing cost and quality information. Industry leaders must understand that a greater degree of transparency is critical to building trust with purchasers and transforming care for consumers. It is also important for supporting the growth of value-based care and reimbursement models.
One example involves clinicians who are participating in accountable care contracts. These clinicians are not only financially responsible for the care they provide, but also for the quality and cost of care delivered by referral partners. Clinicians in these arrangements need to know which potential referral partner has demonstrated the best outcomes, and need this information in a timely, meaningful format in their daily workflows.
The health care industry has just begun to make progress in the areas of price and quality transparency solutions. We are imagining future solutions incorporating new technologies and communication methods based on AI, blockchain and APIs. As we celebrate another annual Health IT Week, the industry needs to come together about what price transparency really means in health care, and how we can help health care consumers make informed decisions by providing them with complete information about the prices, services, and recommended therapies available to them.
Deanne Kasim is senior director of federal health policy strategy at Change Healthcare.
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