Healthcare Reform Stakeholders Summit, Spring 2015 - Episode 7

Healthcare Pricing Transparency Results

The panelists believe healthcare reform transparency has caused a significant reduction in pricing variability, and this has prompted many providers to try to renegotiate rates. Such transparency is also pushing providers to make their pricing information more freely accessible on-line, yet there is some concern that antitrust laws are being used to squash this nascent movement.

Healthcare pricing variability is decreasing tremendously, according to Francois de Brantes, MS, MBA, executive director, Health Care Incentives Improvement Institute, Newtown, Connecticut. Mr. de Brantes describes a report from the state of New Hampshire, the first state to regulate pricing transparency. The report indicates “There has been no effect in prices going up as a result of the transparency.”

This transparency and increased availability of pricing information is causing even the most expensive providers to try to find ways to renegotiate rates to keep their members. Blue Cross and Blue Shield of North Carolina has what Mr de Brantes considers “the most aggressive and well-done transparency tool on pricing.” In fact, “you don’t have to be a plan member… that information is freely accessible on the Web, and they show full episode costs for a number of things [and] the comparisons between the hospitals.”

Arthur Vercillo, MD, FACS, a surgeon and regional president of Excellus Blue Cross Blue Shield, acknowledges that higher-paid providers are worried about the current move toward transparency, “and that’s a good thing.” Dr Vercillo believes products are now being developed with pricing transparency in mind. He explains that nobody wants to be the one charging too little, nor the one charging too much.

Mr de Brantes believes there is no legitimacy to antitrust concerns related to price transparency. “All the arguments that have been put forth are bogus,” he insists, “because if they truly did violate a federal statute . . . or they violated consumer rights, the lawsuits would have gone up to the Supreme Court by now, and they haven’t.” Mr de Brantes adds, “There’s absolutely no legal standing for these arguments.” Dr Vercillo acknowledges the antitrust issue, but believes the benefits of transparency outweigh his concerns, and he is willing to “take the risk of the leverage that could be exerted because the benefit is that big, that important.”