In a world where health care costs are rising and consumers are taking on a growing share, it is critical they have easy access to understandable information about the quality and cost of their care. While we have made decent strides in making quality data available, consumers still have little to no information about health care prices, making it difficult if not impossible for them to seek higher-value care. Numerous studies and articles have explored this problem, such as a recent UCSF study, highlighted in JAMA, which found routine appendectomies can cost as little as $1,529 or as much as $183,000. As PBGH Medical Director Dr. Arnie Milstein so eloquently stated in the Wall Street Journal, “Fantasy baseball managers have more information evaluating players for their teams than patients and referring physicians have in matters of life and death.”
Now Catalyst for Payment Reform (CPR), an independent, non-profit corporation working on behalf of large employers and other health care purchasers to catalyze improvements in how we pay for health services, has just released a suite of tools to catalyze price transparency. The suite includes a first-of-its-kind Statement by CPR Purchasers on Quality and Price Transparency in Health Care, endorsed by several partner organizations, that takes plans and providers to task: give us price data by January 2014.
The statement urges providers to share price information and to allow plans to make their rates transparent to consumers, while spurring plans to allow self-insured employers to use their own claims data freely to work with outside vendors to evaluate data and develop shopping tools to meet their employees’ needs.
Some health care providers―hospitals and physicians — restrict access to price data by prohibiting health plans from making their negotiated payment rates publicly available. This significantly limits price data and price data comparisons in consumer shopping tools.
Meanwhile, some health plans take the stance that they own self-insured employers’ claims data, particularly the payment information, even when employers are footing the bills and health plans are playing only an administrative role. This prevents employers from giving their own claims data to third-party vendors who may have alternative price transparency tools or ways of interpreting the data that employers want.
Freely sharing price data drives innovation―the kind we see on display at Health 2.0, ultimately raising the bar and leading to the development of new and sometimes better tools for consumers. And technology can play an important role in empowering consumers, helping us build a better mousetrap, as former Intel CEO Andy Grove explained in a recent issue of Wired Magazine.
Along with the Statement, CPR also released Comprehensive Specifications for the Evaluation of Transparency Tools, which give purchasers and consumer advocates a means to evaluate transparency tools for consumers, providing valuable insights about the features these tools need to be comprehensive and user-friendly―the holy grail of consumer tools. Regardless of insurance status, it is important to note that maximizing the consumer benefits of price transparency will require attention to medical literacy issues, including the fact that it can be very challenging for most health care consumers to understand medical terms as well as how health care payment works, including their own insurance benefits and billing.
Along with the Statement and Specifications for Evaluation, CPR also released an Action Brief that gives health care purchasers concrete steps they can take to push for greater price transparency. In addition to pushing plans and providers, large employers and others who purchase care, along with consumer advocates, can take a number of steps including engaging in advocacy efforts to promote price transparency. Recent legislation in California, including SB 751 and SB 1196,is a step in the right direction, removing barriers that could ultimately allow Californians greater access to cost data. Other states have taken important steps creating all-payer claims databases.
CPR has set an important and ambitious goal-to drive change in our current system so that by 2020, 20% of payments are tied to value; price transparency is a core strategy to achieving that goal. We invite others to use our tools and join our movement. Organizations can sign on and show their support for transparency by contacting firstname.lastname@example.org.
Suzanne Delbanco, Ph.D. is the executive director of Catalyst for Payment Reform (CPR). CPR is an independent organization led by health care purchasers, with active involvement of providers, health plans, consumers and labor groups working to improve quality and reduce costs by identifying and coordinating workable solutions to improve how we pay for health care in the U.S. Learn more at http://www.catalyzepaymentreform.org/.