Increasing access to meaningful information, including price, cost and quality data on health care services, can aid in efforts to improve health care price transparency and may help mend the health care fragmentation, according to a new policy paper by the ACP.
“Our health care system is undergoing multiple shifts: an increase in insured patients, moving payments to quality-based systems, and ever-increasing data,” Jack Ende, MD, MACP, president of ACP, said in a press release. “Additionally, patients are increasingly responsible for a greater portion of their health care costs through higher deductibles, coinsurance, and cost-sharing making the need for health care transparency even more important. Health care price transparency is an important component to address costs for patients and hold the health care system accountable to those it serves.”
In the policy paper, ACP offers nine recommendations to improve price transparency.
ACP recommended that price information, expected out-of-pocket costs and quality data be transparent to provide consumers, physicians, payers and other stakeholders so they can meaningfully compare and evaluate medical services and products. Whether a provider or clinician is in-network or out-of-network, as well as the total for estimated out-of-pocket payments, should be clearly communicated to a consumer by health plans and health care facilities, ACP advised.
Patient-centered health care value decision-making tools that detail price, estimated out-of-pocket costs and quality data should be developed at varying levels of health literacy by payers, plans and other health care organizations, according to ACP.
ACP also recommended that private and public health plans be legally required to submit standardized data to an all payer claims database. These databases should be able to expand in the future to include information from other sources, such as vital statistics, data from regional health information exchanges or data from quality clinical data repositories, according to ACP.
“Gag clauses” and similar contractual arrangements that interfere with transparency should be legally prohibited, ACP recommended. ACP also advised that payer claims databases be supported by federal grants or similar incentives to states.
Greater efforts should be implemented to protect patients from unexpected out-of-network health care costs, including costs accrued during emergencies or without the patient’s prior knowledge, according to ACP. Furthermore, ACP recommended that there should be state and federal action to decrease the negative effects of surprise billing.
“This is a complicated issue,” Ende concluded. “The health care market is different from other markets and should be looked at in a way that takes into account these unique qualities. However, while also acknowledging the limitations of health care transparency, it is vital to support policies that improve health care price transparency tools; protect patients from high, unexpected out-of-pocket costs when they had little or no control over their care situation; and streamline access to reliable price, cost, and quality data.” – by Alaina Tedesco
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