Pricing Transparency in
Healthcare Reform
Many Americans don’t
know exactly how their
healthcare providers come
up with prices.
According to a recent
report by non-profit
Catalyst for Payment
Reform, this is the fault of
the providers themselves,
who...
They recently gave 45 US
states a failing grade for
neglecting to provide a way
for patients to understand
their expenses.
If patients had access to
data like this, the argument
goes, they would be able
to properly budget for care
down the line.
As it stands now, they are
victims of prices as care is
needed.
What this failing grade
means is this: if you live
there, you cannot readily
find healthcare prices.
With healthcare reform,
more of the cost of care is
shouldered by patients,
which makes meaningful
price information more
...
In the same way that
consumers need to
understand pricing of any
product they buy, they
need to know what
healthcare will ...
particularly since we
can expect healthcare
to be one of life’s
biggest expenses as we
age.
What’s standing in the
way are confidentiality
agreements by insurers,
doctors, and hospitals.
Price negotiations are
kept behind closed
doors, and intentionally
kept secret.
What results is that
consumers won’t have
data to be able to
choose care providers.
One reason this data would
be important is that the same
procedure could have
different prices from hospital
to hospital, ...
Sometimes the amount
a consumer’s insurance
company will pay can
vary too, based on a
number of factors
currently not avai...
Larger hospitals or
hospital systems have
greater leverage to get
higher reimbursement
prices from insurers.
That extra money is
paid by employers and
consumers with higher
premiums and
deductibles.
There has been a
recent wave of
legislators bringing
prices for such care to
the public, through laws
requiring transparen...
Information repositories, also
known as ‘all payer claims
databases’ are being
constructed, providing
accurate and complet...
As of now, such public
databases are only in
Colorado, Maine,
Massachusetts,
Vermont, and Virginia.
Florida is an interesting
case, as they’ve built a
database, but still
received a failing grade.
Their site is managed by the
Agency for Health Care
Administration, and has been
deemed to contain too narrow
a scope of i...
What information is
present is not well
displayed, or very
helpful.
Florida’s legislators are
also not seeking
transparency from
insurers, which is a
necessary piece of the
transparency puzz...
Without this information,
consumers only know how
much the care costs total,
not how much they can
expect to spend out of ...
Pricing Transparency in
Healthcare Reform
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Pricing Transparency In Healthcare Reform

A presentation of information about transparency in healthcare reform. States are currently pursuing ways to make pricing information available to people before they even need it.
Published on: Mar 4, 2016
Published in: Healthcare      
Source: www.slideshare.net


Transcripts - Pricing Transparency In Healthcare Reform

  • 1. Pricing Transparency in Healthcare Reform
  • 2. Many Americans don’t know exactly how their healthcare providers come up with prices.
  • 3. According to a recent report by non-profit Catalyst for Payment Reform, this is the fault of the providers themselves, who are rarely transparent with their pricing methods.
  • 4. They recently gave 45 US states a failing grade for neglecting to provide a way for patients to understand their expenses.
  • 5. If patients had access to data like this, the argument goes, they would be able to properly budget for care down the line.
  • 6. As it stands now, they are victims of prices as care is needed.
  • 7. What this failing grade means is this: if you live there, you cannot readily find healthcare prices.
  • 8. With healthcare reform, more of the cost of care is shouldered by patients, which makes meaningful price information more important than ever.
  • 9. In the same way that consumers need to understand pricing of any product they buy, they need to know what healthcare will cost them,
  • 10. particularly since we can expect healthcare to be one of life’s biggest expenses as we age.
  • 11. What’s standing in the way are confidentiality agreements by insurers, doctors, and hospitals.
  • 12. Price negotiations are kept behind closed doors, and intentionally kept secret.
  • 13. What results is that consumers won’t have data to be able to choose care providers.
  • 14. One reason this data would be important is that the same procedure could have different prices from hospital to hospital, or from doctor to doctor, with no difference in quality.
  • 15. Sometimes the amount a consumer’s insurance company will pay can vary too, based on a number of factors currently not available to the public.
  • 16. Larger hospitals or hospital systems have greater leverage to get higher reimbursement prices from insurers.
  • 17. That extra money is paid by employers and consumers with higher premiums and deductibles.
  • 18. There has been a recent wave of legislators bringing prices for such care to the public, through laws requiring transparency.
  • 19. Information repositories, also known as ‘all payer claims databases’ are being constructed, providing accurate and complete information about pricing by hospital and physician.
  • 20. As of now, such public databases are only in Colorado, Maine, Massachusetts, Vermont, and Virginia.
  • 21. Florida is an interesting case, as they’ve built a database, but still received a failing grade.
  • 22. Their site is managed by the Agency for Health Care Administration, and has been deemed to contain too narrow a scope of information, as well as being a clunky site.
  • 23. What information is present is not well displayed, or very helpful.
  • 24. Florida’s legislators are also not seeking transparency from insurers, which is a necessary piece of the transparency puzzle.
  • 25. Without this information, consumers only know how much the care costs total, not how much they can expect to spend out of their own pocket.
  • 26. Pricing Transparency in Healthcare Reform

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