Price transparency comes to the forefront


Clear, actionable comes to the forefront


The Health Care Cost Institute (HCCI) has developed a partnership with Aetna, Humana and UnitedHealthcare to provide a free online tool that will offer consumers comprehensive information on price and quality of health services.

The new tool will aggregate pricing data from commercial plans, as well as Medicare Advantage and Medicaid plans, if the states agree, says David Newman, executive director, HCCI. HCCI will create and administer the information portal, which is expected to be available in early 2015.

“While the details are not yet known about the HCCI initiative, we are pleased with any development that brings more useful information to consumers, and look forward to seeing how it progresses,” says Robin Gelburd, president of FAIR Health, a national independent, not-for-profit corporation created in 2009 to bring transparency to healthcare costs and insurance information.  

“When we were created, cost transparency was not mentioned everyday in the newspaper, on the web or in various media outlets,” says Gelburd. “We sort of came onto the landscape with a set of mandates to create the consumer website, which was really one of the first of its kind at that time.”

FAIR Health’s claims database contains more than 16 billion records contributed by more than 60 insurers and claims administrators. It’s accessible online and is free to the public. 

Over the last several years, stakeholders have recognized  the marketplace paradigm shift, Gelburd says. 

“You cannot change to the reimbursement design and various models of cost-sharing for the consumer; change network design and all these other elements that are critical to the health plan and not keep pace with the kind of education and transparency they need,” she says. “Providing transparency is a win-win for all stakeholders, and the water level rises for everyone when there is a shared set of data points that are actionable and allow people to make sound decisions.”

For example, she says, if a beneficiary is unsure about cost-sharing requirements and what a certain procedure will cost, it doesn’t benefit a plan to have a confused or angry member on the phone with customer service or lodging an appeal based on having insufficient information. This only creates time and resources spent on what could have been resolved at the front-end with the proper dissemination information.

“Each minute, literally, that a customer service representative is dealing with a member, that’s money spent by a plan and frustration for the consumer,” she says. “Much greater goodwill is created between members and their plans if there’s [better] information.” 



Transparency vs clarity

Transparency is often not enough. ‘Clarity’ better respresents the overall goal of contextualizing information for consumers, Gelburd says.  

For example, dirty dishes chaotically piled up in a sink is transparent to the eye, but does not provide clarity. Taking the dishware and assembling it on a table does. 

FAIR Health offers a reimbursement 101 segment on its website to help consumers with difficult healthcare terms, offering definitions in plain language.

“We took the time to create clarity about what the meaning of those terms are, because you can’t just provide cost information to a consumer and expect it to be clear,” Gelburd says.

Maximizing benefits

In the new B2C environment, plans are seeing an appetite for rich information. Educational content and data provide opportunities for plans to reach out to the consumer and determine how to make plan designs digestible so members can maximize benefits appropriately. 

“Health insurance information can be intimidating and impenetrable,” she says. “[Plans] must be sensitive to the need to create information that’s actionable but also makes sense.

Additionally, consumers don’t always realize the three-dimensional nature of healthcare costs. For example,  needing a colonoscopy might translate to simply paying the gastroenterologist performing the procedure. It’s important to prompt  the consumer with data about anesthesia or pathology, Gelburd says, because they may need to consider associated costs. 

Eliminate confusion 

With health reform taking place in real time, Gelburd says it’s too early to determine what methods will ultimately work best. Certain ways of presenting information will gain traction, but transparency will likely evolve over the next few years. 

Similarly, not all transparency tools are created equal. What makes one valuable is the data supporting it. 

“It’s like ingredients to any meal,” she says. “You want to be certain that they are of top quality and are rich and robust in order to ensure data integrity, and that it’s independent and reliable so greater confusion isn’t introduced into the marketplace.”

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