The California Department of Insurance has launched a tool for consumers to compare price and quality information for providers in their region.
In doing so, California joins states such as Colorado, New Hampshire and Maine, which have sought to make price information more transparent. But concerns persist about the level of data available and whether consumers can use it to comparison-shop.
The site, California Healthcare Compare, allows consumers to search for the average price of about 100 common medical procedures and conditions, including caesarian sections, knee replacement surgery or chest pain. The data includes the average price as well as the price range in a particular county, including the total amount paid to providers, the amount insurance pays and the amount that an insured patient would be expected to pay.
Consumers also can search for procedures by hospital, which are rated for quality and patient experience on a five-point scale. The hospital search will bring up the average total price providers receive in that area, but not provider-specific data.
The state received a $3.9 million grant from HHS and partnered with Consumer Reports and the University of California, San Francisco to build the platform.
The proliferation of high-deductible plans has increased the need for transparency around price and quality, said Dave Jones, the state insurance commissioner.
“Californians, until this moment, have really struggled to get price information,” he said. “Having price information really matters as consumers have to dig into their own pockets.”
The data have confirmed one trend in the state: Providers in Northern California are paid as much as 50% to 100% more than those in the Southern California for the same service. But the site doesn't allow consumers to find out what a specific provider is paid for a service.
For that level of granularity, California would need to establish an all-payer claims database similar to the ones in New Hampshire or Massachusetts, Jones acknowledged. “I'm hopeful that stakeholders will demand the information,” he said. “I think consumers will insist on it.”
The price information comes from Truven Health Analytics, which supplied data from more than 10 million claims during 2010 to 2013.
Yet the more immediate goal of the website was to give consumers information on how much providers are paid so that they can negotiate payments when they go out of network, said Doris Peter, director of the health ratings center at Consumer Reports.
Momentum around price transparency has been building across the country, but questions remain about whether the current tools are useful. While a majority of consumers have tried to find price information, they're least likely to use a third-party website to do so.
Instead, consumers are asking their friends, relatives and colleagues for information, according to a survey of about 2,000 people from Public Agenda and the Robert Wood Johnson Foundation. They're also asking at the point of care, seeking information from a receptionist or doctor's office staff. But only 17% of respondents have turned to a website not associated with their insurer.
“They're asking people they know, which is normal,” said David Schleifer, senior research associate at Public Agenda, a not-for-profit research group. But it's unclear why they're skipping over third-party sources, he added. “It may mean that they don't know how to find reliable or trustworthy information.”
Although 56% of respondents had sought price information, the survey found that most people were checking prices for just one provider. In follow-up interviews, a number of respondents said they either didn't have many choices in their area or they trusted their doctor and didn't want to go elsewhere.
But a more pressing problem may be a lack of awareness.
Less than half of respondents, or 43%, knew that some doctors charge more than others. “There's a very significant share of Americans who don't know that prices vary,” Schleifer said. Still, those people who did compare prices, saved money on medical care, he added.
