Calls for Transparency in Healthcare Pricing Gain Steam

One of the most vexing problems in managed care is the lack of pricing transparency: patients can't act like consumers when they don't have information on what they are buying. This week, the need for healthcare pricing transparency took center stage in several places.

From public employees in Miami, to state legislators in California, to payment reform experts gathered yesterday in Boston, calls are increasing to make transparency in healthcare pricing the next piece of the reform pie.

All week, the Miami Herald has chronicled the frustration of administrators and employees alike in Miami-Dade County, where a labor-management committee has been working toward greater contributions to healthcare from union workers. The effort has been stymied by the inability of the county’s health plan administrator to provide prices for procedures at individual hospitals. This is happening despite the fact that Miami-Dade County is self-insured, something that is not uncommon when the plan administrator, not the employer, negotiates the pricing contract.

This creates one of the most vexing problems in managed care: How can patients become smarter healthcare purchasers if they don’t know the prices of what they are buying? As the movement continues to reform the U.S. healthcare delivery system, from a fee-for-service model to one that rewards value, not volume, transparency in healthcare pricing has taken center stages in several places this week.

Besides Miami, there’s the Health Care Forum 2014 in Boston, hosted by The Economist, where speakers told the gathering that patients can’t be expected to behave like consumers if they aren’t given the right tools. And consumers need more than just pricing information — they also need comparative information about quality, data that is only at its early stages of being gathered.

In recent years, organizations have sprung up to help push for pricing transparency reform, with the group Catalyst for Payment Reform issuing report cards to states based on the quality of laws requiring pricing disclosure. Most state grades were in the “D” or “F,” range. This summer, California was attempting to pass a law that would require broad disclosure, but the bill’s status is unclear after it passed the Senate in July.

Groups like FAIR Health say that consumers want pricing information and deserve to have it. “It’s an exciting time for consumers and hopefully they will embrace these tools as they become more available through the Web and through various forms of other media,” said Robin Gelburd, president at FAIR Health, previously told The American Journal of Managed Care.

Around the Web

AJMC Video: Robin Gelburd on Pricing Transparency

Many States Don’t Require Disclosure of Prices for Medical Procedures

Healthcare price averages don’t give Miami-Dade tools to cut costs

Price Transparency First Step Toward True Healthcare Reform