Without improved transparency and access to information about the prices and quality of healthcare services, providers will be unable to achieve the triple aim and consumers' efforts to make informed decisions when shopping for healthcare will be stifled, according to an op-ed in The Hill by former Senators Bill Frist (R-Tenn.) and Tom Daschle (D-S.D.).
Mr. Frist and Mr. Daschle suggest the following four steps for payers, providers, patients and policymakers to spur greater transparency in healthcare, according to The Hill.
1. Supply more information on insurance exchanges. According to Mr. Frist and Mr. Daschle, consumers need access to more comprehensive information on the health exchanges they use to purchase insurance plans, especially with the rise of high deductible health plans and increasingly narrow networks. Such information should include explanations of cost-sharing, up-to-date lists of which providers are in-network, information about quality ratings of health plans and the quality of care delivered by network physicians.
2. Improve transparency around payment data. States should make all of the data they collect from all-payer claims databases or their equivalent freely available to users so they have a better sense of the cost of care, according to Mr. Frist and Mr. Daschle. Additionally, states should ban the "gag" clauses in providers' and insurers' contracts that prohibit either party from sharing payment arrangements.
"To be sure, payment data isn't the same as pricing data, but understanding the big variations in levels of payment that permeate the healthcare system may help the movement to a more rational payment and pricing structure," the former senators wrote.
3. Make better use of data that is already accessible. Providers, insurers and others can use data, information and transparency tools that are already available to understand healthcare costs and guide efforts to improve the quality and efficiency of care. Mr. Frist and Mr. Daschle cite the Agency for Healthcare Research and Quality's Health Care Cost and Utilization Project as one such tool, as it is already collecting data on 97 percent of hospital discharges in the U.S., as well as data on discharges from emergency departments and ambulatory surgery centers. According to the two former senators, state-level policymakers can use AHRQ software to create public reporting websites on providers' quality scores and cost information.
4. Encourage dialogue between providers and patients on quality and cost. Providers and patients should also take the initiative to discuss strategies to prevent unnecessary care and waste. According to Mr. Frist and Mr. Daschle, there are several resources available to aid these conversations. The American Hospital Association offers a guide to hospitals on how to improve transparency with consumers on costs and prices, and Choosing Wisely, an initiative of the ABIM Foundation, aims to promote discussions between clinicians and patients by helping patients choose care that is evidence-based (not duplicative of other tests or procedures they've already received), free from harm and truly necessary.