Healthcare Reform Stakeholders Summit, Spring 2015 - Episode 5

Healthcare Pricing Transparency

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.”