As an industry effort to bring awareness to the rising costs of healthcare, organizations, state governments, and health plans are beginning to share the true cost of care through transparency. In theory, transparency could slow the rising costs of healthcare ─ if patients are given the opportunity to “shop” for their care, high-price providers will be forced to lower their numbers to remain competitive.
As the popularity of high-deductible health plans increases, more consumers are seeking answers upfront as they attempt to reduce their out-of-pocket costs for immediate or long-term care. Patients must have access to lower costs, higher value, and increased efficacy in order for our healthcare system to stabilize and progress.
The Importance of Transparency
Healthcare without transparency is like grocery shopping without price stickers. Not knowing what you’ll be paying out of pocket, how much your insurance will be billed, or how much the procedure, visit, or operation costs significantly diminishes value. If a patient wishes to research options for their upcoming procedure but can’t find cost information, they’re forced to choose the care their physician referred or the care with the best reviews or recommendations. However, the goal isn’t to secure the cheapest care; it’s to find the highest value of care—the correct healthcare at the right price.
Unfortunately, there’s currently no consistent relationship between cost of care and quality of care. This allows care providers to hike costs without proving their value. As a result, patients may be overpaying for mediocre care that can be obtained at a more affordable cost. The availability of cost and quality information can encourage informed decisions and increase a patient’s likelihood of choosing high-value care, visiting a new provider, and obtaining lower clinical care payments.
Navigating the Challenges of Effective Transparency
So far, over half of our country’s states have implemented legislation that requires healthcare plans, doctors, and hospitals to provide a cost breakdown or establish a website or app that display costs for patients. Yet, despite some patients having access to full cost transparency, many patients are unaware of cost breakdown. A study conducted by the Journal of American Medical Association showed that despite patients having access to pricing apps and websites, they’re not using them. Only 20% of patients ended up using these tools within two years of access, and overall, it did not reduce outpatient or out-of-pocket spending.
Providing more information hasn’t resulted in lower spending for several potential reasons including:
- The experience of searching for lower prices and quality care is too complex or may overwhelm the patient.
- Not all health care can be shopped for. A Health Cost Institute analysis stated that about 40 percent of health care is related to non-emergencies and situations where the patient will save out of pocket.
- By nature, patients may believe that higher cost means higher quality. Unfortunately, only half of price transparency tools include information about the experience and care quality.
- The question still remains: How does the healthcare industry better balance the relationship between the value and cost of care? In addition to transparency, perhaps the following alterations could aid the progress of healthcare in our country:
- Altering the construction of health insurance. For example, by requiring a patient to pay the difference between a preset “average” price and the higher cost plan they choose.
- Increasing outreach to inform patients of better value providers.
- Establishing an incentive for patients to acquire lower cost and equally efficacious care.
- Increasing awareness to alter patients’ heath care habits as transparency becomes more readily available.
Educating patients to do their research before committing to a provider is essentially unlearning the process they’re used to. It’s no longer required for patients to visit the only doctor recommended to them by a physician, hospital, or clinic. There are tools for consumers to begin understanding their costs and needs and preference for high-value care.
Canopy Health Believes in Transparency
Canopy Health partners with reputable health plans to offer affordable insurance products for consumers and employers. Contact us at 888-8-CANOPY with any questions about our healthcare alliance and how we can transform your clients' healthcare benefits.
Al-agba, N. Price Transparency and All Its Very Large Warts. (2017, March 11). The Health Care Blog. Retrieved from http://thehealthcareblog.com/blog/2017/03/11/price-transparency-and-all-its-warts/
Characterizing Health Plan Price Estimator Tools: Findings from a National Survey. (2016, February 16). American Journal of Managed Care. Retrieved from https://www.ajmc.com/
Frakt, A. Price Transparency Is Nice. Just Don’t Expect It to Cut Health Costs. (2016, December 19). The Health Care Blog. Retrieved from https://www.nytimes.com/2016/12/19/upshot/price-transparency-is-nice-just-dont-expect-it-to-cut-health-costs.html