14 organizations pushing for more transparent hospital pricing
Last week, Massachusetts became the first state to require health insurers to post real-time pricing for healthcare services, by provider, online.
The move didn't get much press (perhaps because the state has put in place a series of regulations to make pricing more transparent over the last few years), but is significant. It provides consumers with a way to compare provider pricing for a certain test or procedures under their specific health plan.
As consumers take on more responsibility for the cost of their care, one can expect more state action around healthcare price transparency. However, state lawmakers aren't the only ones pushing for price transparency. Leading the charge for price transparency are a number of nonprofit and for-profit entities, each with their own motivations to push for more information on healthcare pricing and quality.
The George Washington University Master of Public Health Program recently released a list of 14 organizations taking the lead in healthcare price and quality transparency efforts. Here are the organizations identified by the program; healthcare leaders who are ready for transparency may find it wise to partner with such groups. Leaders of organizations that lack competitive pricing, or where pricing is not tied to value, should be very worried about the work these groups are doing.
1. Choosing Wisely — This initiative from the American Board of Internal Medicine Foundation promotes evidence-based medicine and the elimination of unnecessary tests and treatments. While it doesn't offer specific pricing information, the campaign (which is now backed by 60 medical specialty societies), offers educational resources to providers and patients, as well as lists of the most common unnecessary tests and treatments and guidance to help patients avoid receiving them.
2. California Health Care Foundation — This nonprofit group's mission is to improve healthcare for California residents, and greater transparency for healthcare quality and pricing is one of its main platforms. Its leaders have lobbied California lawmakers and testified to state assembly members to promote more transparent information on healthcare services.
3. Castlight Health — For-profit Castlight Health provides healthcare price and utilization data to large employers. Its stock IPO was one of the largest this year, raising $3.2 billion. Customers include Wal-Mart, CVS Caremark and Liberty Mutual.
4. Catalyst for Payment Reform — Formed by a coalition of large employers, Catalyst for Payment Reform advocates value-based payment reforms by employers and other healthcare purchasers and publishes an annual National Scorecard on Payment Reform.
5. Clear Health Costs — Founded in 2010, the website includes Medicare reimbursement rates for healthcare services across the country, as well as cash-page (or chargemaster) rates for providers in select metropolitan areas, including New York City, San Francisco and Dallas. The site is run by investigative journalists and funded by a number of grants. While it only currently includes chargemaster data (which many argue doesn't reflect the rates many patients or insurers actually pay), it does at least offer some comparative information by putting the data in one place and making it publicly available.
6. Change Healthcare — Founded in 2007, the for-profit company provides healthcare cost information to employers and health insurers, who then make the tool available to their employees or members. The data is intended to help individuals make better healthcare decisions. The company also produces the Healthcare Transparency Index, a measure of the costs and cost variability of different healthcare services.
7. Costs of Care — Neel Shah, MD, an assistant professor at Harvard Medical School, practicing OB/GYN and leading advocate for healthcare transparency, established Costs of Care in 2010. The organization creates educational materials and hosts events aimed at helping physicians-in-training better consider the costs of care in their treatment decisions. The group is also developing a mobile app to help aid clinicians in taking costs into account during clinical decision-making.
8. Council for Affordable Health Insurance — The CAHI is a research and advocacy association that promotes market-based solutions to healthcare affordability problems. The group was established in 1992 by a group of healthcare insurers. The group performs in-depth analysis on applicable legislation and advocates on behalf of its members.
9. Emergency Care Research Institute — The ECRI Institute is a nonprofit organization that performs research and offers advice around healthcare safety, evidence-based medicine and cost-effective healthcare. The group produces an annual price guide with data on what healthcare providers pay for supplies and services. While the data in the price guide doesn't include information on prices paid by consumers or insurers for healthcare services, the prices providers pay for supplies and services does affect the prices they ultimately charge patients and payers.
10. FAIR Health — The FAIR Health database was created in 2009 as part of a settlement between the New York State Attorney General and a number of insurers for use of Ingenix, a flawed database owned by UnitedHealth Group to determine out-of-network rates. FAIR Health received nearly $100 million in funding from the settlements and is maintained by Syracuse University. It includes information on out-of-network rates as well as consumer information on the reimbursement process.
11. Healthcare Bluebook — Founded in 2008, Healthcare Bluebook aims to do for healthcare what the Kelley Blue Book did for cars. Its website and mobile app allow consumers to compare cash-pay prices for healthcare services and medications by zip code. The site also has a tool that links prices for procedures by certain providers with quality and patient ratings from HealthGrades.com.
12. Health Care Cost Institute — The Health Care Cost Institute was created in 2011 by Aetna, Humana, Kaiser Permanente and UnitedHealthcare to create a database of private payer healthcare costs and utilization data that could be made accessible to researchers and policymakers. Previously, researchers and policymakers had to rely largely and Medicare and Medicaid data for research and to inform policy making. The HCCI makes previously inaccessible private-payer data available for these purposes. The group also releases an annual Health Care Cost and Utilization Report.
13. Health Care Incentives Improvement Institute — HCI3 was created by the merger of the Prometheus payment project, an initiative launched in 2007 and funded by the Robert Wood Johnson Foundation to test new, value-based payment models, and Bridges to Excellence, an organization formed in 2003 to identify and test ways to reward providers for high-quality care. Recently, HCI3 partnered with Catalyst for Payment Reform to release the Report Card on State Price Transparency Laws.
14. Price Transparency Task Force — HFMA's price transparency task force, established in 2013 by the Health Care Financial Management Association, provides guidance to healthcare leaders about consumer-friendly reimbursement processes and improving cost transparency. Its 2014 report, "Guiding Principles and Recommendations for Price Transparency," includes steps insurers, hospitals, consumers and employers should take to improve healthcare price transparency.