Healthcare Reform Stakeholders Summit, Spring 2015 - Episode 6

Pricing Transparency Tools for the Consumer and the Provider

Some price transparency tools aim to provide real-time healthcare information to patients’ on their out-of-pocket costs, deductibles, and information on variation between certain physicians and providers. As important as this information is, tools of this type are not widely available. The panelists also discussed the relevance of the available information, and whether it is making a difference for consumers, as well as for providers in terms of contracting and overall expenditures.

Castlight Health and Truven Health Analytics, among others, offer price transparency tools that allow patients to track their out-of-pocket costs, deductibles, and other relevant information in real time. Such technology is a big step forward, explains Ateev Mehrotra, MD, MPH, associate professor of health care policy and medicine at Harvard Medical School and hospitalist at Beth Israel Deaconess Medical Center. Yet, says Dr Mehrotra, survey data show “the vast majority of people…trying to shop for care aren’t using such websites because their employer doesn’t have them available or they don’t even know about it….It just doesn’t really work.”

To the extent possible, some of these price transparency tools are designed to couple the costs and the out-of-pocket costs with quality, explains Arthur Vercillo, MD, FACS, a surgeon and regional president of Excellus Blue Cross Blue Shield. Dr Vercillo asks, “What if having an arthroscopy is going to be 20% less in one place versus another, but the infection rate is 10% higher?” This type of data is what truly matters to patients.

Francois de Brantes, MS, MBA, executive director, Healthcare Incentives Improvement Institute, believes pricing transparency has truly changed negotiations with providers and affected spending. Available data are making a difference in terms of contracting and overall expenditures, he says, and although the amount of data as well as their relevance will vary, “The core of the information exists.” Mr de Brantes explains how state legislations are trying free up information so entrepreneurs can then make tools readily available to consumers as well as providers.

There is a potential downside of having a lot of previously unavailable information, says Dr Mehrotra, who is “just struck with the knowledge that the hospital down the street is getting paid 20% more than I.” Dr Vercillo acknowledges that “Providers are all curious as to where they stand relative to their peers in terms of not just cost, but quality also,” and will eventually use those data to their advantage.