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How Can Providers Support Meaningful Price Transparency for Consumers? | HIT

So, where does consumerism intersect price with transparency? The short answer is “everywhere” and the longer answer shows that most patients remain “passive” consumers of healthcare, especially when the patient is an established and frequent user of services.3 When we think about how this impacts overage consumption of care, patients who have a level of comfort with their provider tend to stay with that provider. Other factors—such as the ability to compare cost data—are needed in order to induce a new type of consumer behavior.4

Lately, as we look longitudinally across the healthcare landscape, we begin to see changes in this old mode of passive behavior. One factor is the increase in high-deductible health plans, accounting for nearly half of the population covered by a commercial health plan, including patients who obtain insurance through their employer and those who buy coverage independently.5 For providers, this means that patients/consumers are the third largest payor behind Medicare and Medicaid, a status that is behind the push for greater transparency through more access to meaningful data.

With a focus on transparency and patient empowerment, the CMS Inpatient Prospective Payment System (IPPS) rule gives patients new access to price information, mandating hospitals to publish their standard charges online in a machine-readable, searchable format.  In an ideal world, this information could and should be used for patients to make informed decisions about the provider and location of their care, however, we find that this information adds another layer to an already complex process. Searching the computer-readable formats and the Medicare “Procedure Price Lookup” requires a knowledge of procedure codes or at least a working knowledge of the procedure that the provider has described. Without accompanying quality data, how do patients know if the less costly institution has the same outcomes as the more expensive institution—in the case of healthcare, we cannot reliably correlate price with quality.

We know that the CMS rule is an important step toward using price transparency in order to reduce the overall cost of U.S. healthcare. However, the current approach to the delivery of this price information to patients/consumers highlights some of the challenges reviewed with healthcare as a service, namely the application of generalized data to non-archetypal patients. Delivering price information is not only a good thing for the national healthcare market and for patients, but it is one of the most impactful ways that providers can support patients on their healthcare journey, while also improving the overall financial viability of the hospital or health system.

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How Can Providers Support Meaningful Price Transparency for Consumers?.

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