Healthcare pricing is making a slow shift toward transparency, having long been veiled in opacity. Although some recent legislation aims to effect change in this pricing obscurity, it is difficult for the general public to make educated and informed healthcare purchasing decisions without price transparency.
The healthcare industry has “reveled in opacity for as long as anyone can remember,” says Francois de Brantes, MS, MBA, executive director, Healthcare Incentives Improvement Institute. He believes that is changing, however. Mr De Brantes’ Institute and the Catalyst for Payment Reform issue joint report scores for each state’s healthcare pricing transparency. Although “The majority of states will get an F,” he expects improvement heading into 2016. Mr De Brantes contends that payers and providers can no longer label such pricing information confidential or proprietary.
People “want to know what is it they’re buying,” insists Arthur Vercillo, MD, FACS, a surgeon and regional president of Excellus Blue Cross Blue Shield, adding, “It is high time that [healthcare pricing became] transparent.” Noting the health plan levels—platinum, gold, silver, bronze—which are primarily defined by the out-of-pocket expense that a person must pay, Dr Vercillo points out that a person with a bronze plan is responsible for 40% of the costs. Simply, “The people who can least afford it have the most skin in the game, so they want to know what it is they’re buying.” He considers it is very difficult for the public to make sound healthcare purchasing decisions without access to all pricing information.
Ateev Mehrotra, MD, MPH, associate professor of healthcare policy and medicine at Harvard Medical School and hospitalist at Beth Israel Deaconess Medical Center, and evangelist for price transparency, identifies the movement toward transparency as a very positive development for our healthcare system. “We need to make this more patient centric” for it to be effective, says Dr Mehrotra, who describes the tremendous variation in prices and the complicated nature of price transparency. “We need to create a mechanism so it’s a lot easier for patients.”
Health Equity and Access Weekly Roundup: April 27, 2024
April 27th 2024Racial disparities in end-of-life care, the role of wellness and faith in minority health, award-winning research on health disparities, societal factors impacting cardiometabolic health, and rising mental health challenges among US youth are all covered this week in the Center on Health Equity and Access.
Read More
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
Listen
Dr Kathy Zackowski Discusses the Importance of Rehabilitation Research and Trials in MS
April 26th 2024Kathy Zackowski, PhD, National MS Society, expresses the inherent value of quality rehabilitation trials for broadening clinical understandings of multiple sclerosis (MS) and bettering patient outcomes.
Read More
Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
Listen