Illuminating Health Care Prices: Organizations to Watch

Illuminating Health Care Pricing: Organizations to Watch

Health care costs have increased three times faster than wages over the past decade. Just like any marketplace, prices for medical procedures, equipment and treatments vary dramatically among providers. An appendectomy can cost anywhere from $1,529 to $186,990. A hip replacement could run from $11,100 to $125,798. But trying to determine the actual price you’ll pay — or the one you should be paying — can be daunting for the average consumer. And once that pricing information is available, how can we aggregate and utilize it to make health care more affordable for everyone? Here, we’ve broken down the issue of health care price transparency and profiled fourteen exciting, effective and innovative organizations that support it in different ways.

“In 2014, we make purchasing decisions for every other commodity based on transparent price and quality information. Why not healthcare, too?” — Dr. Neel Shah, Costs of Care

 

 

 

 

Price Transparency: What’s at Stake

Proponents of health care price transparency contend that publishing price information could both rein in the extraordinary range of costs people pay and lower the level of prices in general. This kind of price transparency empowers consumers to comparison shop for health care as they would a car, house or television, forcing higher priced providers to lower their prices to stay competitive.

Price transparency is at a crossroads as millions of previously uninsured Americans receive greater access to medical care under the Patient Protection and Affordable Care Act (ACA). Many of these people opted for one of the less expensive “bronze” or “silver” plans, which typically cover 60 to 70 percent of the costs of treatment. There’s no doubt this is a great improvement over not being insured at all. But, in the case of an appendectomy, a patient on a silver plan could be responsible for $458 or $56,000 depending on where the procedure takes place. Without access to meaningful price information, how would a patient know what to expect when the bill arrives?

There are many factors contributing to the variations in health care pricing. Some areas have higher operating expenses, such as in New York City versus North Dakota. Sometimes, the same medical procedure can be conducted in a different, more expensive way by using high-tech equipment or newer, more expensive drugs. Another reason for variations in price are provider or hospital markups, which have been shown to be exorbitant at times, marking up cotton swabs or routine X-rays by 400 percent.

“You get what you pay for” is not always true in these high-cost situations. There is little evidence supporting a relationship between higher health care costs and health care quality. More importantly, few people would know where to begin to access and assess price and quality indexes in order to make well-informed decisions. Frequently, consumers first see their bill when it arrives after the procedure, which may leave them feeling taken advantage of. This has the effect of eroding trust in the health care system as a whole.

Stalling the unprecedented growth of health care costs is thought to be essential to the long-term fiscal stability of the United States. This is thought to be so important, in fact, that over 30 states have passed or have proposed legislation to increase price transparency. A majority of state-run initiatives publish average or median prices for individual services, but many proponents of price transparency favor reporting of all amounts paid to every provider for every service so trends can be tracked with actual data. They also contend that this kind of reporting acts as a disincentive for backdoor deals that they contend contribute to escalating health costs in general.

Not surprisingly, insurance companies are some of the most vocal opponents of price transparency. Insurance companies negotiate prices with hospitals and providers largely in secret, allowing them to get better deals for their consumers. Insurance providers claim that their ability to pass these negotiated lower costs onto consumers would be compromised if they had to publish their negotiated rates to competitors. They also contend that hospitals may decide not to negotiate with them at all, leaving their customers with rising costs.

Some opponents of price transparency argue that aggregating the massive amount of data needed to keep price reporting accurate is difficult to collect and audit for accuracy. Others say that price transparency could actually raise the price of health care, and still others point out that releasing price information would be a hollow objective if it is not paired with quality outcome data — meaning the price data would have no real value. In the absence of value, it is possible that consumers might assume a $125,798 hip replacement is better than an $11,100 one, causing the provider of the $11,100 and others to raise prices to stay competitive (and make more money per procedure in the process).

Who’s Leading the Charge?

Many organizations and initiatives, however, are dedicated to achieving greater price transparency and decoding its complicating factors. Some of these organizations create resources that help providers have a frank discussion about prices with their patients. Some educate patients regarding the extreme variation in health care pricing and help them compare prices before pursuing a treatment plan. Others are dedicated to ensuring that data — once it has been made transparent — is accessible, contextualized and comprehensible. Read more about their efforts below.

American Board of Internal Medicine Foundation — Choosing Wisely
www.choosingwisely.org
Founded: 1999 (American Board of Internal Medicine Foundation)

Choosing Wisely is an initiative of the American Board of Internal Medicine Foundation (ABIM) that promotes open dialogue between providers and patients to choose treatment plans that are supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary. “We’re more focused on appropriateness,” says Daniel Wolfson, Executive Vice President and COO of ABIM. “‘Is this test or procedure appropriate for this patient at this time?’”

Choosing Wisely also works to make sure that patients have a full view of the costs, both monetary and otherwise, associated with a care plan and to include costs as part of the discussion which crafts that patient’s care. The program asks medical providers to “choose wisely” the tests and procedures for each patient, even if they are widely used in their field.

“We do think it’s important for there to be awareness of what things cost and getting the information around cost, What’s really going to be important is how physicians have those conversations about what things cost.”

Part of the problem, Wolfson suggests, is the fact that physicians often feel responsible for determining appropriate or necessary care, but not for the cost of that care: “Keeping the patient engaged in their care is the responsibility of the physician. If it’s an affordability issue that is going to prevent treatment from happening, then there needs to be a discussion about that. I think providers need those skills.”

The Choosing Wisely initiative has been working with Consumer Reports Health to provide patients with better information about their options for care. It also partners with consumer groups and other professional medical associations to disseminate patient-friendly materials. The campaign has not been independently evaluated, but the common sense, patient-friendly approach has inspired replication in Canada by the Canadian Medical Association.

California Health Care Foundation
www.chcf.org  

@CHCFNews
Founded: 1996
President and CEO: Sandra R. Hernández, M.D.

The California Health Care Foundation (CHCF) is a nonprofit that provides grants totaling around $35 million that improve clinical outcomes and quality of life for Californians with chronic disease. One of the foundation’s main goals is promoting greater transparency and accountability in the health care system. The foundation is a leading force behind price transparency at the state level in California, convening task forces and meetings to fine-tune policy.

As a leader in health care advocacy in California, the CHCF has been very influential in bringing health care cost transparency to the attention of influential Californians. In 2009, Maribeth Shannon, director of CHCF’s Market and Policy Monitor program, testified as an expert before the California Assembly Committee on Health regarding transparency, quality data and outcomes in a testimony called “What Is Transparency in Health Care and Why Does It Matter?” In her testimony, Shannon stressed the importance of providing data that works for the consumer, stating, “Where quality is largely independent of what kind of coverage a patient has — though some may debate that — cost is very specific to an individual’s insurance coverage, benefit design and financial situation. What
 is important here is to know not the average price but to know ‘my price.’”

“What
 is important here is to know not the average price but to know ‘my price.’” — Maribeth Shannon, California Health Care Foundation (CHCF)

“There are really two problems,” says Shannon, with regard to some of the bigger issues facing the transparency movement. “The first and most important is lack of data. In California, pricing data is largely unavailable. Sharing what is available – billed charge information, or average regional pricing – is just not helpful. People want information specific to their circumstances: to know what they will pay (given their plan design and the provider options available to them), not what some people charge. The second major problem is that up until very recently consumers did not research their health care options. Is that because there wasn’t useful data? Partly. But it is also because many people are locked into networks – they go where their physician or health plan tells them to go.”

Incentives, or lack thereof, can also contribute to whether or not people research their options. “Most people in California are still covered through HMO plans (though that is starting to change). If it costs you a fixed co-pay amount, regardless of where you go, there is no incentive to shop for a better deal. With the introduction of the Covered California program (Obamacare), there is some new movement toward higher deductible plans, so maybe the market is beginning to change and more people will be subject to deductibles – increasing their financial incentive to shop for ‘best value.’”

More recent efforts, such as the 2013 briefing “Inside the Black Box: The Future of Price Transparency in California”  addressed data collection issues, the ongoing need for price transparency, and thefuture of price transparency in California.

Castlight Health
www.castlighthealth.com
@CastlightHealth
Founded: 2008 by Todd Park, Bryan Roberts and Giovanni Colella
CEO: Giovanni Colella

The founders of Castlight felt the tools being offered, primarily by health insurers, were opaque at best and set out to make something better. What makes the resulting tool not just better, but completely innovative, is that it offers both price information and quality metrics for tests and procedures in the same place. The tool is available to the employees of businesses who have subscribed to the service as a web application that aggregates cost data from the subscribers’ insurance companies along with quality, usage and coverage metrics. The Castlight Health tool has an added benefit in that the subscribing business can use the data from the tool to adjust the benefits it offer its employees.

Catalyst for Payment Reform
www.catalyzepaymentreform.org  


@CPR4healthcare
Founded: 2009 by a group of employers, including Pacific Business Group on Health
Executive Director: Suzanne F. Delbanco Ph.D.

Catalyst for Payment Reform (CPR) was created to work toward payment-model reforms and act as a catalyst for those reforms. CPR has a holistic approach to payment reform, from reporting on shortfalls in the current system to providing a solutions framework to establishing connections and collaborations to align efforts of different interests including policymakers. “At CPR, we like to say price transparency is one of the core building blocks of payment reform and a higher-value health care system,” says CPR Executive Director Suzanne Delbanco. “Purchasers and consumers need transparency for three primary reasons: (1) to help contain health care costs; (2) to inform consumers’ health care decisions as they assume greater financial responsibility; and, (3) to reduce unknown and unwarranted price variation in the system.”

“In some pockets of the country, we still have issues getting price data because health care providers and health plans use gag clauses in their contracts with each other to prohibit sharing information on paid amounts with consumers,” Delbanco continues. “But even where gag clauses do not exist, some consumers still can’t find meaningful price information. Some may be fortunate enough to have access to a price transparency tool provided by their health plan or employer. But some don’t. And very few states actually have laws that require health plans and health care providers to make this information available to consumers.”

One of the greatest accomplishments of CPR is the creation and dissemination of an innovative Payment Reform Toolkit. Geared towards employers’ evaluation of health plans during the decision-making process, the toolkit provides employers with model contract language to use when formalizing their expectation that health plans implement innovative payment models, delivery models and quality metrics. The toolkit provides an overall framework and map for nationwide payment reform and aligns some of the best in public and private sector strategies. The main components are guidance on market assessment, action briefs, aligned sourcing information, health plan user groups utilization, comprehensive specifications for the evaluation of transparency tools and an example how-to guide for implementing a bundled payment program for total joint replacement.

Clear Health Costs
www.clearhealthcosts.com
@chcosts
Founded: 2010
CEO: Jeanne Pinder

Clear Health Costs was started with a $20,000 grant from the CUNY Graduate school of Journalism and has gone on to be awarded grants by the International Women’s Media Foundation and the New Media Women Entrepreneurs project. Why are all of these prestigious institutions so excited? Clear Health Costs offers consumers pricing information for health-related procedures and treatments in seven U.S. metropolitan areas: New York, San Francisco, Los Angeles, Dallas-Fort Worth, Houston, San Antonio and Austin. The prices, listed as total cash price without insurance, offer a clear and easy way to compare prices at specific health care providers. The site gives provider names, contact information and addresses in order to make it easy to take advantage of the information provided.

“With the rise in high-deductible plans, higher co-insurance and more out-of-network, out-of-pocket spending, people are really interested in this right now,” says Clear Health Costs CEO and founder Jeanne Pinder.

“Increasingly, people are seeing the effects of our opaque marketplace in their checkbooks, and they’re horrified.” — Jeanne Pinder, Clear Health Costs

The cost information on Clearhealthcosts.com comes from two different sources. The first is an interesting crowd-sourcing experiment. The second is the staff of Clear Health Costs, who are primarily investigative reporters. These two sources result in real-world pricing based on what actual patients are paying. For instance, a well woman exam at a New York City 5th Avenue gynecological office is $150, while one just a few blocks away at a Madison Avenue practice is $350.

“We are really enthusiastic about state governments and other organizations that have used the data they have to make consumer-friendly tools…[but] one drawback of some of these tools is that they’re limited to hospital claims,” says Pinder. “As you might suspect, we are partial to our pricing survey methodology: We collect cash or self-pay prices for common procedures that we regard as ‘shoppable’ from a comprehensive range of providers in seven U.S. metro areas. We juxtapose those cash or self-pay prices, reported by the providers themselves, with the Medicare paid rate — the closest thing to a fixed or benchmark price in this market.”

Pinder says that the discussion about rising costs was “present but muted” before the Affordable Care Act. Now, however, “people have brain space to look at the money, and they’re horrified. There’s a consumer dynamic awakening in this country around medical costs.”

Change Healthcare
www.changehealthcare.com  

@ASKCH
Founded: 2007
President and CEO: Douglas Ghertner

Change Healthcare is a private company that seeks to change the way people purchase and use health care service by driving engagement on an individual level. It is the nation’s leading provider of health care cost information, with over 7 million users in all 50 states. The Change Healthcare tools are subscription based and can be accessed by individuals associated with an employer or insurer who is part of the program. The program uses quality, cost and convenience data to help individuals make health care decisions and manage their out-of-pocket costs while receiving high-quality care. Change Healthcare also has a program for employers, Healthcare University, that helps clients learn to take full advantage of available health benefits.

Change Healthcare President and CEO Douglas Ghertner says his direct interactions with consumers during his tenure at CVS/Caremark initially drew him to the Change Healthcare mission. “[At CVS], I had an opportunity to interact with a lot of our clients. People were regularly insulated from the cost. That caused me to start looking at the space differently. You see this overarching trend of consumerism in healthcare…and I think that trend will continue.”

Change Healthcare also recently began to publish quarterly reports of all medical claims of all Change Healthcare clients: Change Healthcare’s Healthcare Transparency Index (HCTI). The HCTI provides a comprehensive report of costs and cost variability of different health care services and includes a Transparency Matrix, which assigns health care services to high and low-cost categories.

Ghertner says consumers are more aware than ever before of what they’re paying for health care costs. “Generally, there’s an overarching familiarity with the importance of transparency. All of [these groups] are now talking about transparency, and that’s a positive. The ACA in and of itself — it just highlights the need for these types of tools.”

“It’s not just all about price. It’s about price and quality.” – Douglas Ghertner, Change Healthcare

Costs of Care 


www.costsofcare.org

@CostsofCare
Founded: 2010 by Neel Shah, M.D.
Executive Director: Neel Shah, M.D.

“In 2014, we make purchasing decisions for every other commodity based on transparent price and quality information (think Yelp, Travelocity),” says Costs of Care Executive Director Neel Shah, M.D. “Why not healthcare, too?”

The question speaks directly to the Costs of Care mission, which Shah started while he was an OB-GYN resident with the aim of designing materials to help doctors-in-training learn to make clinical decisions that optimize care and cost. The organization brings together the best medical educators, practitioners and health care economists to collaborate on the materials, collectively called the Teaching Value Project. The teaching modules are presented as part of the familiar ethical framework of “do no harm” and make learning to be conscious of patient costs a moral imperative for aspiring doctors and experienced practitioners alike.

To support the learning modules, Costs of Care is in the process of building decision-support tools, including a mobile application to help doctors take in all considerations during their clinical decision-making process. Vineet Arora says that funding from the ABIM Foundation, the organization has also been able to launch a Teaching Value and Choosing Wisely Challenge — which enters its second year later this fall– to “identify the most promising ways to incorporate teaching about value into medical education.”

Shah says that the transparency movement has grown exponentially since he started Costs of Care in 2010. “What started as a cottage industry less than five years ago has become a booming movement to empower patients with information on the cost of care,” he says. “The inflation and arbitrariness of healthcare pricing has dominated media stories from the cover of Time Magazine to a recurring series in the New York Times. The rapidly increasing focus on transparency has been partly catalyzed by growing numbers of price-sensitive patients on high deductible plans and partly driven by the way the internet has evolved.”

Council for Affordable Health Insurance
www.cahi.org
Founded: 1992
Interim Executive Director: Marianne Eterno

The Council for Affordable Health Insurance (CAHI) is an association of insurance carriers that conducts research and advocacy to promote affordable insurance through market-oriented solutions. It works to advocate for health-reform measures that benefit all players in the American health care market through thorough evaluation and dissemination of analysis, positive or negative, of health care reform measures. Board members of the CAHI regularly advise Congress and state legislators and are often called to testify formally. The CAHI produces high-quality policy analysis and collaborates with an extensive network of other organizations to disseminate its message.

Emergency Care Research Institute
www.ecri.org
@ECRI_Institute
Founded: 1968
President and CEO: Jeffrey C. Lerner, Ph.D.

The Emergency Care Research Institute (ECRI Institute) is a nonprofit that has been bringing applied scientific research to health care for over 45 years. Its current mission is dedicated to discovering which medical procedures, devices, drugs and processes best enable improved patient care. ECRI Institute is a designated Evidence-Based Practice Center by the U.S. Agency for Healthcare Research and Quality and a federally certified Patient Safety Organization by the U.S. Department of Health and Human Resources.

Since 1996, the ECRI has published pricing information on single-use medical products from information provided by hospitals. This PriceGuide External link can be found online and is used by member hospitals to track costs. In 2007, the ECRI was involved in a landmark lawsuit against Guidant, a manufacturer of pacemakers who claimed that ECRI’s publication of prices was not lawful. ECRI won the case by asserting that it is in the national interest to allow health care providers to engage in comparison-shopping.

Since 2012, the ECRI has been collaborating with Modern Healthcare to publish a Technology Price Index, which provides a snapshot of average prices paid by providers for 30 key capital and supply items based on data from ECRI Institute member facilities. This index is updated monthly and includes graphs for the top 10 supply items by total spending, the top 10 most expensive capital items and the top 10 most popular capital items. This index is aimed at helping health administrators keep tabs on the ups and downs of the industry.

ECRI Institute has other supports available for the general public and for health care providers alike including articles, policy statements and other resources.

FAIR Health
www.fairhealthconsumer.org
@FAIRhealth
Founded: 2009 as a result of action by New York State Attorney General
President: Robin Gelburd

“Not everyone has been a doctor, but everyone has been a patient,” says FAIR Health President Robin Gelburd. She’s worked in health care for more than 25 years.

In 2009, an investigation by the New York State Attorney General’s office uncovered conflicts of interest within the Ingenix database that health insurers used to calculate reimbursement for patients who received care from out-of-network providers. The resulting settlement allowed the insurers to not admit any wrongdoing in exchange for funding a new database to be run independent of the insurance industry. The result was the FAIR Health database.

“Not everyone has been a doctor, but everyone has been a patient.” – Robin Gelburd, FAIR Health

“It’s like we’re living in a laboratory in real-time,” says Gelburd of the evolving transparency movement. “It’s really been rewarding to see that there has been a change in the conversation. I think everyone recognizes that the train has now left the station. There are a variety of factors that are necessitating transparency to move forward…[and] narrowing tiered networks that require consumers to roll up their sleeves and determine what kind of care they want to receive.”

“In the absence of transparency, there’s a lot of legal static,” she continues. “There’s a lot of confusion and surprise bills, which really erode the relationship between patients and their employers, plan representatives and providers. It makes sense to arm consumers with good information.”

But transparency, she says, is just the beginning of a much bigger undertaking. Even if more data about health care costs – think the recent releases from the Center for Medicare and Medicaid Services – becomes accessible, will the average consumer be able to make sense of it and use it to make educated decisions about their care?

“For us, transparency isn’t even the catch word anymore. We see a huge difference between transparency and clarity…We try to not create a chaotic pile of data, but really contextualize the data and use language that is comprehensible that gives people a foundational understanding.”

In addition to providing out-of-network reimbursement rates, FAIR Health also offers data products for research and policymaking in addition to providing patients with clear information regarding the reimbursement process through www.fairhealthconsumer.org.

Healthcare Bluebook
www.healthcarebluebook.com  

@HCbluebook
Founded: 2008 by CareOperative, LLC
CEO: Jeffrey J. Rice, M.D., J.D.

Healthcare Bluebook founder and CEO Jeffrey Rice knows first-hand the extent to which prices can vary for a given procedure. When his son needed surgery, the first facility he queried wanted to charge his family $3,700. Upon further consultation with his son’s physician, though, they were able to locate a nearby facility that was just as good – one that charged only $1,500.

“Patients need to understand that there is enormous price variation in health care. If you’re going to buy a gallon of gas, it might be $3.85 at one pump and $3.10 at another. In health care, the equivalent is $4.00 to $20.00.” — Dr. Jeffrey Rice, Healthcare Bluebook

Healthcare Bluebook is a private enterprise that provides free online and mobile tools to help consumers find fair market cash prices for medical care. The website lists thousands of procedures, tests, medications and services and their fair market cash price by zip code. Healthcare Bluebook also allows consumers to view a “Fair Price” which is the amount that should be paid for a particular service. The Fair Price is calculated by the amount that providers are paid for services, a price that is often lower than the provider’s billed charges for a cash-payment patient.

Healthcare Bluebook also gives consumers the option to print a “binding price estimate” agreement based on the data that a patient can take to a health care provider to facilitate and empower patients negotiate fair rates for services. There are other unique tools on the website such as tools that group network providers into cost ranges for certain procedures and cost data presented against patient reviews and quality ratings from HealthGrades.com.

“When we started doing this, most patients definitely did not know that there were variations in pricing. Even large employers, five years ago, didn’t understand what this opportunity represented,” says Rice. But there’s still plenty of work to do. “My company’s job is to make sure that every patient gets the same care that I can get for my own family.”

Health Care Cost Institute
www.healthcostinstitute.org
@HealthCostInst
Founded: Created in 2011 by Aetna, Humana, Kaiser Permanente and UnitedHealthcare
Executive Director: David Newman, Ph.D., J.D.

The Health Care Cost Institute — a research institute and data repository — tackles a different dimension of the transparency issue: Once we have what is truly an insurmountable amount of health care data, how do we organize it and make it accessible to experts capable of interpreting it?

The world has been, for the past two years, mesmerized with the concept of big data, and big data can be messy,” says David Newman, Executive Director of the Health Care Cost Institute (HCCI). “It can be unwieldy, difficult to work with both from a structural perspective and in terms of having adequate resources from a machine perspective to deal with large data.”

That challenge in mind, HCCI was created to design a database to give researchers and policymakers unprecedented access to health care cost utilization data including data that was previously inaccessible anywhere but the private insurance market.

“In order to improve the care people are getting, we need to improve the ability to bring [health care] data into one place.” Dr. David Newman, Health Care Cost Institute (HCCI)

HCCI is able to access this previously out-of-reach data because it is funded and created by top insurance providers. The sheer volume of data available in the HCCI database makes it unique among providers in this area. The database contains medical and pharmacy claims for 50 million Americans from all 50 states and the District of Columbia since the year 2007 and includes the actual amounts paid by both the insurers and the amount that came out of the patient’s own pocket. The goal of this database is to promote research and policy that is based on better information as to what is driving the rising costs of health care.

“In order to improve the care people are getting, we need to improve the ability to bring all that data in one place,” says Newman. “Our hope is that we assemble a large enough data set so that others can derive insights that are actionable.”

The HCCI also releases annual reports available here.

Health Care Incentives Improvement Institute
www.hci3.org
@HCI3_org
Founded: Bridges to Excellence was founded in 2003, and later merged with PROMETHEUS Payment to form HCI3.
Executive Director: Francois de Brantes, M.S., M.B.A.

“We’re encouraged to see a shift in the conversation move from wishful thinking to part of the every day health care dialogue,”says Health Care Incentives Improvement Institute (HCI3) Executive Director Francois de Brantes. “Not only are we are seeing more demand from consumers for price transparency information, we are also seeing examples of it being put to use and reducing costs.” HCI3 is a nonprofit made up of physicians, employers, health plans and other stakeholders that work together to create programs that measure health outcomes, reduce care deficits and promote a team approach to caring for patients and realigning payment incentives to reflect quality and reward excellence.

“HCI3‘s mission is to improve the quality and affordability of health care. While there are various ways to do that, making medical prices public and actionable is a huge component,” de Brantes continues. This past March, HCI3 worked with Catalyst for Payment Reform (CPR) to release the second annual Report Card on State Price Transparency Laws. The results, says de Brantes, were “less than stellar”: 45 states failed and just two received a B for their efforts. Determining what consumers know, and what they need to learn, is another component to consider: “While there’s a huge opportunity as price transparency efforts take hold to better serve patients and drive down health care costs, many hurdles remain. One obstacle is to educate consumers that low price does not equal low quality, and visa versa.”

Understanding what quality means in relation to price is another challenge: to that end, HCI3 has also developed episodes of care definitions (called Evidence-informed Case Rates, or ECRs) which include Potentially Avoidable Complications, or PACs, to help incorporate the possibility of complications into consumers’ calculus when they shop around for prices: “In short, the higher the PAC rate a doctor has, the more likely you are to pay for extra services, such as corrective surgery or longer hospital stays.”

HCI3 also runs INQUIREhealthcare.org, which provides tools and resources to find high-quality doctors, sample questions to ask at appointments, and how to demand price transparency from their local providers and state legislators.

Health Care Financial Management Association — Price Transparency Task Force
www.hfma.org
Task Force Website: www.hfma.org
@hfmaorg
Founded: HFMA was founded in 1946 by William G. Follmer. The task force was founded in 2013.
CEO: Joseph J. Fifer, FHFMA, C.P.A.

The Health Care Financial Management Association (HFMA) is an organization that brings together stakeholders to identify gaps in the health care delivery system and then bridge those gaps through knowledge sharing and establishing best practices. The Price Transparency Task Force is made up of health providers, insurers and consumer groups such as Catalyst for Payment Reform. The task force is charged with crafting guidance as to how consumers can get clear, easy-to-understand information about health care costs before they undergo any procedures or treatment. The resulting report “Guiding Principles and Recommendations for Price Transparency” provides recommendations for how providers can ensure their patients have access to reliable health care cost information.

“The most significant factor that has changed the discussion on price transparency is the rapid growth in high-deductible health plans in both employer-sponsored insurance and plans offered on the exchanges,” says James Landman, who is Director or Healthcare Finance Policy, Perspectives and Analysis at HFMA. “Consumers are responsible for more of the health care dollar than before, and their interest in—and need for—price information has grown accordingly. Employers, who are working to manage the cost of providing health insurance to their employees, are also very interested in tools that can direct employees to higher value providers—those that offer quality outcomes at a competitive price.”

The task force also had the forward thinking to recognize that price transparency could have unintended consequences such as impacts on price negotiations within the business-to-business marketplace. The task force also recognized that the best solution for price transparency may not be a one-size-fits-all model. It recommended different networks for different patient groups such as insured patients, uninsured and out-of-network patients, employers and referring clinicians. This makes the task force’s approach one of the most tailored in the industry.

“Consumers are responsible for more of the health care dollar than before, and their interest in—and need for—price information has grown accordingly.” – James Landman, Health Care Financial Management Association (HFMA)

Moving Forward

Regardless of your position on price transparency, there is no doubt that these tools and resources are powerful and, if used wisely, can educate consumers and contribute to our nation’s ongoing fight to control health care costs while improving overall health and wellness. Some of our nation’s best and brightest are involved in these ventures, and their combined efforts are sure to make a lasting impact on how we manage our health care costs going forward.