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All healthcare stakeholders are accountable for price transparency, a  report finds

Price transparency needed from all stakeholders, HFMA task force says


By Rachel Landen
Posted: April 16, 2014 - 1:30 pm ET
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Hospitals and health plans should serve as front-line resources on healthcare price information for patients who want to make more informed decisions about their healthcare. But government and employers should also help consumers understand healthcare prices, according to a report released today by a task force promoting guidelines and recommendations for price transparency.

“We believe that it will take everyone—providers, insurers, employers and government—working together to provide patients with the information they need,” Rich Umbdenstock, president and CEO of the American Hospital Association, said in a statement on the Healthcare Financial Management Association's website. “This includes helping patients understand their hospital bills by finding better ways to explain them in user-friendly terms. “

Led by HFMA, task force participants—health plans, providers, consumers, employer groups and physician groups—agreed that health plans should be the primary source of price information for their members, and that hospitals should serve as the central resource for uninsured and out-of-network patients.

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“People everywhere want to be smart healthcare consumers, but information about healthcare prices is not easily accessible,” Joseph Fifer, president and CEO of HFMA, said in a release. “For too long, it has been unclear how consumers should go about getting price information—who to ask, what to ask for, or what the information even means when they do receive it. This approach is a game changer.”

The task force called on health plans to communicate information to their members about estimated prices for various healthcare services, patients' estimated out-of-pocket responsibilities, whether a particular service provider is within their network, and other relevant outcomes, safety and patient satisfaction data. For Medicare and Medicaid beneficiaries, the task force recommended that government agencies adopt a similar approach to price transparency and comparisons in advance of tests and procedures.

The responsibility should fall on providers, the task force said, when dealing with uninsured and out-of-network patients. And even employers should get involved, the task force suggested, by giving their employees access to transparency tools.

The AHA was one of 23 groups represented on the task force, which also included the Leapfrog Group, the American College of Physician Executives, and America's Health Insurance Plans, among others.

“Up until now, there's been a lot of finger-pointing in the industry, but this is a time when we all got in the room and hashed it out,” Fifer said. “I can't remember another time, with something as important as this issue, when a group of this nature and diversity has come together and really coalesced.”

Since the task force convened in September, Fifer said all stakeholder groups have signed on. “What it means is there is a broad avenue of distribution of this information,” he said.

In addition to its report, the task force developed a consumer guide to assist consumers in asking useful questions about healthcare pricing and helping them find the right resources to get those questions answered. The guide contains specific instructions for those with and without insurance, and insured patients seeking care in and out of network. It also includes a glossary of health coverage definitions, explaining terms such as “the Affordable Care Act,” a “high-deductible health plan,” and “premium,” as examples.

Some health plans, providers, state hospital associations and other groups have already developed transparency tools for their patients and consumers that HFMA and the task force also recommend.

In 2012, UnitedHealthcare launched its myHealthcare Cost Estimator, an online and mobile calculator that patients can use to compare prices on in-network providers and get personalized estimates for nearly 300 treatment episodes.

Spectrum Health, Grand Rapids, Mich., has been publishing the average estimated price, average Medicare payment, average Medicaid payment and average insurance payment for a range of common procedures since 2006. The health system also offers secure phone and email options for reaching a pricing specialist who can answer related questions.

Just one day before HFMA and the task force introduced their recommendations, the California HealthCare Foundation and the Robert Wood Johnson Foundation released a report analyzing price transparency initiatives in New Hampshire, a state leader in price transparency.

In 2003, New Hampshire began collecting provider price information for an all-payer claims database. Four years later, the state launched a public website providing median-bundled prices for about 30 common procedures.

Its report, Moving Markets: Lessons from New Hampshire's Health Care Price Transparency Experiment, based on interviews with healthcare stakeholders and experts, suggested that the website's use was modest for consumer price-shopping, but light usage was ascribed in part to its lack of applicability for the uninsured. And even with a report card sponsored by the New Hampshire Purchasers Group on Health, the researchers said meaningful quality information was lacking.

The HFMA-led task force repeated in its report the need to recognize that price information should be paired with quality, safety and outcomes metrics.

Follow Rachel Landen on Twitter: @MHrlanden


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