|Health Plans Ramp Up Hospital-Physician Price And Quality Transparency Tools
While health plans are developing tools to help
consumers compare price and quality information about hospitals and
physicians, the tools’ pervasiveness and usefulness are limited,
according to a study released by the Center for Studying Health System
Responding to large employers’ interest in greater
healthcare price and quality transparency, health plans generally
provide some price information on inpatient and outpatient procedures
and services, according to the study.
However, the information often lacks specificity about
individual providers, and its availability is often limited to
enrollees in specific geographic areas.
Likewise, few plans provide price information on
services in physicians’ offices. When providing quality
information, health plans generally rely on third-party sources to
package publicly available information instead of using information
from their own claims, the study found.
"While health plans are devoting a lot of attention to
price and quality transparency tools, we’re a long way from a
critical mass of consumers trusting and using the information to choose
physicians and hospitals," said Paul B. Ginsburg, president of HSC, a
nonpartisan policy research organization funded in part by the Robert
Wood Johnson Foundation, which funded the study.
Many large employers view price and quality transparency
as key to a broader consumerism strategy, where employees take more
responsibility for medical costs, lifestyle choices and treatment
decisions. Some health plans view providing price and quality
information to enrollees as creating a competitive advantage, while
others are skeptical about the benefits and are proceeding cautiously
to avoid potential unintended consequences, the study found.
"None of the health plans we interviewed believed that
price and quality information is being used extensively by their
enrollees today, in part, because few have incentives in their benefit
structures to encourage cost comparisons," said HSC Health Researcher
Ann Tynan, coauthor of the study with HSC Health Analyst Allison
Liebhaber and Ginsburg.
The study is based on HSC’s site visits to
12 nationally representative metropolitan communities: Boston;
Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock,
Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix;
Seattle; and Syracuse, N.Y. HSC has been tracking change in these
markets since 1996.
Other key study findings include:
- Few plans provide price information that is
customized to reflect individual enrollees’ benefit design. Only
one health plan interviewed — Humana — reported having Web
site capability to allow for individual customization of price
information based on an enrollee’s deductible, copayments and
- Few health plans reported providing price information
for physician services; when they do, they generally provide the
average cost of physician office visits in a particular geographic
area, sometimes by city or zip code, and these costs are not specific
to particular physicians.
Plans are weighing the advantages of providing price and
quality information against potential pitfalls. Plan executives
perceive one of the biggest risks to be the misinterpretation of price
and quality information by consumers. Health plan respondents were
particularly concerned that enrollees may interpret high price as a
proxy for high quality and shift to higher-cost providers, thus raising
costs, but not necessarily improving quality.
Address: Center for Studying Health System Change, 600 Maryland Ave. SW, Suite 550, Washington DC 20024; (202) 484-5261, www.hschange.org.