Healthcare Business News

Transparency wanted

Organization calls for release of price data

By Jessica Zigmond
Posted: November 3, 2012 - 12:01 am ET

A new initiative from some of the nation's large employer groups just added another item to the 2014 to-do list for health plans and providers: Make healthcare price data available to employees and consumers.

The healthcare industry, employers and lawmakers are already looking ahead to 2014, when many key Patient Protection and Affordable Care Act provisions—such as the establishment of health insurance exchanges and certain employer requirements regarding coverage for workers—are scheduled to take effect. And now the Catalyst for Payment Reform, a not-for-profit organization representing large U.S. employers such as Boeing, FedEx, GE and Wal-Mart, has set that year as a target date in its new statement that calls on health plans and providers to make pricing information transparent.

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By January 2014, according to the statement, providers should remove any barriers on health plans from making price and quality information available in their transparency tools, and health plans should allow self-insured customers to use their own claims data—including releasing that data to a third-party vendor—to develop transparency tools. Several organizations support the statement, including the AARP, the AFL-CIO, the National Business Coalition on Health, the Leapfrog Group and the Pacific Business Group on Health.

“The basic idea is that as a group, employers and purchasers feel price transparency is an essential ingredient of the healthcare system,” said Suzanne Delbanco, executive director of the San Francisco-based Catalyst for Payment Reform. “As we ask employees and consumers to foot more of the bill or be responsible, it's almost impossible without healthcare price transparency.”

Along with the statement, CPR developed a set of transparency-tool specifications that Delbanco said could help employers and others who need to choose a transparency tool for their consumers, and also help the makers of those tools, such as health plans or independent vendors. The guidelines address utility, accuracy, consumer experience, and data exchange, reporting and evaluation.

The CPR statement contends that some healthcare providers are still reluctant to release price and quality information, an issue that Ginny Proestakes, director of health benefits at GE, said will likely be the greatest barrier in this effort.

“There are a lot of contracts with providers that prohibit the sharing of data,” Proestakes said. “Health plans need to provide that, and some providers continue to resist this,” she added.

Elizabeth Curran, head of national network strategy and program development for Aetna, said the company has worked on cost and quality transparency since 2002, when a number of providers were unwilling to release cost information. But the advent of consumer-driven health plans, she said, has helped change that.

“Early on, physicians and hospitals were concerned how patients would use this information,” Curran said. “But consumers have shown we're a savvy lot. We know how to cost compare and we do that in every other aspect of our lives.”

Still, Tom Nickels, senior vice president for federal relations at the American Hospital Association, said there are certain business arrangements between hospitals and health plans that should remain confidential. He underscored the part of CPR's statement that said some “unintended consequences” could develop from greater transparency in price and quality information, such as providers using the information to raise their prices.

“I think within certain limits, it's fine,” Nickels said. “But again, there are limits to transparency. The most important thing for a consumer to know is their financial obligation when they receive a service, and that is primarily between an individual and an insurer.”

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