A look at the landscape in health care price transparency

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

Photo: Tax Credits via Flickr

Photo: Tax Credits via Flickr

High deductibles and out of pocket costs – which are increasing in both Affordable Care Act exchange plans and employer-sponsored coverage – have given new urgency to helping patients (or “consumers” as they’re called nowadays) learn about the cost and quality of care.

If you know both cost and quality, you know more about the value of care. (Assuming the treatment actually is the right and necessary course of care, but that’s a whole other conversation.)

Many programs and experiments are underway to figure out which tools are helpful to patients, how patients are using them, and what are their impact on health spending and utilization. The findings so far can perhaps be summed up as  “meh.”

The Robert Wood Johnson Foundation recently held a meeting of experts who took stock of the current state of price transparency. Summing it up on the Health Affairs blog, Megan Collado of Academy Health and Andrea Ducas of RWJF make the following points:

  • Patient demand for price comparison information is on the rise, but relatively few people actually use it.
  • People generally don’t understand that some doctors charge more than others for the same services.
  • There’s mixed data on whether clinicians actually order fewer tests when they are given information on prices at the point of care. (Some earlier research indicated they did cut back on ordering when they had the economic information on hand.)
  • Individuals, particularly if they are low-income or vulnerable, “may lack the market power needed to effectively improve the value of the health care system.”
  • That implies a greater role for physicians as financial stewards. But, for a variety of reasons, doctors often are uncomfortable talking about the cost of care with patients. That suggests the need for more research into “how provider behavior may be changing as prices become more transparent and as consumers are exposed to increasing amounts of cost sharing.”

If you’ve tried to shop for health care for yourself or anyone close to you, you know how hard it can be to find meaningful and easy-to-use information. Yet all of us on the health care beat hear buzzwords such as “value,” “transparency” and “consumer empowerment” all the time.

Here are a few articles, issue briefs, and tools (some by academics, but not too technical) that highlight some trends and challenges. These resources should help you understand what patients and providers are experiencing and how your community stacks up:

  • JAMA: Health Care Price Transparency and Economic Theory by Uwe E. Reinhardt, D. (This link is to the first page, but those with media access can get the whole thing).
  • A consumer guide to health care pricing from the Healthcare Financial Management Association (HFMA). The guide is from 2015 and written from an industry perspective, but still gives insight on how providers and payers are thinking about this.
  • The Catalyst for Payment Reform has done a lot of work on this topic. Here’s a map showing how your state compares with others on price transparency – an easy starting point for a story.
  • Here’s a recent Health Affairs post by Catalyst’s Executive Director Suzanne Delbanco and her CPR colleague Lea Tessitore that gives an easy to understand overview of the field. It notes that with consumer information so limited, plans and employers have to step up in the meantime.
  • A look by Health Leaders Media at the ripple effects on providers when one state’s Blue Cross Blue Shield plan made pricing (though not quality) data public.

You also may want to check two earlier AHCJ posts (here and here) on price crowdsourcing by ClearHealthCosts.com.

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