Learn the Issues: Quality/Pricing Transparency
What are quality initiatives and pricing transparency?
While employers buy things every day based on quality IT systems, financial services, equipment many businesses dont know what they are getting for their health care dollar. Until recently, employers and employees have not had information on how much individual physicians and hospitals charge or their quality and performance track records. Increasingly, employers are demanding health care pricing and quality information, arguing it is the only way to compare health care options and make choices based on value.
How do they affect the business community?
Several recent trends in how employers provide health benefits to their employees -- purchasing health care based on value, health plan benefit design, and consumer-directed health plans depend on employers and employees having better information on price and quality so they can vote with their feet.
To achieve greater transparency in quality and pricing, we must overcome the following challenges:
Price and quality information has been considered proprietary.
So long as providers continue to charge different prices to different payers, employer-specific pricing information needs to be made available,.
Medical providers dont always agree on how to measure quality.
Detailed clinical information useful for creating quality indicators is often stored in paper medical records (rather than searchable electronic databases), which limits the quality information that can be provided.
Current information is hard for employers and employees to understand.
Health plans, providers, employers, and government will need to take the following steps to improve transparency:
Agree to share information about price and quality.
Standardize billing and quality information, with input from the medical community, to provide apples-to-apples comparisons.
Use computers to record health information.
Present information in easy-to-read formats, similar to Consumer Reports.
Recent developments:
The Colorado Legislature took several steps toward increasing transparency in pricing and quality by enacting the following during the 2008 session:
Requiring the Division of Insurance to provide a consumer guide on its Web site and requiring insurance brokers to disclose compensation to their clients (House Bill 1385).
Supporting the expansion of health information technology by providing funding to the immunization registry and the Colorado Regional Health Information Organization (CORHIO).
Adding quality measures to the Colorado Hospital Report Card that track health outcomes likely to be affected by nurse staffing levels (Senate Bill196).
At the federal level, President George W. Bush issued an executive order in 2006 requiring federal health care programs (Medicare, Medicaid, etc.) to make relevant information available
in a readily useable manner.
Insurers have also been developing transparency tools for their members. In 2005, Aetna became the first health plan to provide enrollees with online access to prices paid for common doctor services. Aetna Navigator/DocFind was designed to help consumers, especially those facing high deductibles, learn what an individual doctor will charge them before going in for a visit. Several other carriers have since launched similar systems, some of which provide clinical quality information in addition to pricing.
While these carrier tools are reserved for enrollees, the Colorado Business Group on Health publishes quality information on health plans and hospitals that is available to everyone online.
Resources:
HospitalCompare
Informative federal government Web site for comparing hospital quality measures.
Ucomparehealthcare
Provides both pricing and quality measures. UCompareHealthCare is a part of About Inc., a New York Times Company.
Colorado Health Plan Report Cards
Colorado Business Group on Health
Rates Colorado health plans on various quality measures
National Health Policy Forum
Describes progress and barriers toward greater price transparency.
For technical assistance and employer tools related to quality/pricing transparency, see:
Colorado Business Group on Health