Price transparency should start with insurers


Insurers, providers and some of their lobbying groups have issued new recommendations that give payers a leading role in advancing price transparency in healthcare.

The Healthcare Financial Management Association, which convened the task force that created the price transparency report, said all consumers should have access to medical costs as well as other relevant information, including quality and outcomes data.

Moreover, price transparency efforts must include clear, readily accessible information that enables consumers to make meaningful comparisons among providers. Pricing information should be easy to use and communicate, according to the report.

"We need to own this as an industry. We need to step up," HFMA President and CEO Joseph Fifer said, according to The Washington Post.

The task force, which included America's Health Insurance Plans, agreed that insurers are well positioned to help members understand the costs of medical services and should serve as the primary source of medical pricing.

The report recommends insurers help members estimate their expected out-of-pocket costs using their current deductible, copayment and coinsurance information. Transparency tools offered by insurers should:

  • estimate the price of each service;
  • indicate whether providers are in-network and how members can find networked providers;
  • explain the member's estimated out-of-pocket payment responsibility; and
  • provide any other relevant information, including clinical outcomes, patient safety or patient satisfaction scores.

To supply this information, insurers must have access to pricing information for multiple providers in every geographical area covering their networks so consumers can incorporate costs when deciding which provider to see.

"I think that the focus now, unlike three years ago when it was on access, the focus is about affordability," AHIP President and CEO Karen Ignagni told the Post. "What are the prices being charged? It leads consumers to want to know, 'How do I evaluate all that?'"

To learn more:
- here's the HFMA report (.pdf)
- read The Washington Post article

Related Articles:
New tool allows consumers to compare plans
The price is not right: A need for healthcare transparency
Reference pricing saves insurers, patients money
Get consumers to treat medical care like a car purchase
On a quest for price transparency, drop confidentiality clauses
Insurers ramping up price transparency efforts