Lack of transparency regarding expenses of health care services hinders the patient’s ability to make true value-based decisions. Health care markets are prevented from operating efficiently due to lack of complete, accurate and timely information regarding cost of health care services. Meaningful price transparency can empower patients to make informed care decision and it can also help lower healthcare costs.
Resources should be developed to tackle patient confusion and poor health literacy. This can assist patients in understanding complexities of health care pricing and persuade them to seek information about cost of health services that they receive or are planning to receive. All health professionals and entities should make information about prices for common services and procedures readily available. Information about cost of their professional services should be communicated by physicians to individual patients, taking into consideration the insurance status of the patient—such as self-pay, in-network insured, or out-of-network insured.
Complete information regarding plan benefits and real-time, cost-sharing information associated with both out-of-network and in-network service provider services or other plan designs which may affect the patient out-of-pocket cost should be provided to plan enrollees or their designees by health plans. Price and quality transparency for patients and physicians should be facilitated by health plans, public and private entities and other stakeholder groups by working with each other. Processed should be in place to ensure accuracy and relevance of information provided by entities promoting price transparency tools. All-payer claims databases should be strengthened and supported. Features that assist in facilitating price transparency for physicians and patients should be included by Electronic Health records (EHR) vendors.
Dependency of health care financing system on complex arrangements between and among employers, third-party payers, providers and patients has resulted in lack of transparency in health care pricing and costs. These arrangements can make it difficult to spot accurate and relevant information regarding costs associated with specific medical services and procedures. For example, contracts offered by payers to providers frequently delineate contracted rates as proprietary information. Outdated directories or confusion about multiple plan contracts make it hard for patients to determine whether a physician or other provider is in-network. Pricing also varies based on where the service is performed, which can affect the cost, along with patients’ out-of-pocket costs.
Value-based care decisions require not only cost but quality information. It is a hard task to integrate cost and quality information in a usable format in transparency efforts. Metrics of quality is still lacked by many care services.