Catalyst for Payment Reform

MYTHBUSTER: We’ve Solved the Problem of Lack of Transparency

MYTHBUSTER: We’ve Solved the Problem of Lack of Transparency

Back in 2012, CPR issued a statement on behalf of our purchaser members and other health care organizations affirming that information about the price and quality of health care services should be broadly available to those who use and pay for care.

Specifically, we stated that:

  1. Consumers must have access to meaningful, comprehensive price and quality information to make informed health care decisions.
  2. Providers and health plans must make such information available.
  3. Self-insured purchasers have the right to use their claims data to develop benefit designs and tools that meet their needs.
  4. Current anti-trust laws should be adhered to and enforced to ensure proper use of price information by providers and health plans.

So, here we are in 2017 – five years after our initial call to action. Things have changed, the market has evolved, and we’ve solved the problem of price and quality transparency, right? Wrong.

In HCI3 and CPR’s 2016 Price Transparency Report Card we again found that too many states still fall far short of requiring and implementing thorough, useable transparency resources. In fact only 7 states got a “passing” grade of ‘D’ or above. The remaining 43 states fail to make adequate transparency information available to the public.

Furthermore, while most major national health plans offer tools to their members and 53% of employers reported offering a transparency tool in 2016, many Americans remain unaware that prices can vary by provider and that price information is even available. This can lead to low utilization of the tools offered by health plans and employers.1

However, the need for transparency just keeps growing, as more and more consumers are covered under benefit designs asking them to shop around for care. It is estimated that deductibles have increased roughly 67% since 2010, and nearly 25% of employees are enrolled in high-deductible health plans.2 When consumers are trying to find the best care for their dollar, how can they avoid getting a bum deal if they don’t have access to price and quality information? Likely they can’t. And as a result, they could not only over pay for care, but receive care that is low quality, or even results in further complications down the road.

Although it’s undeniable that some progress has been made on transparency, we’ve still got a ways to go to achieve a truly transparent health care market.

Myth busted.



Want to learn more about how price & quality transparency fit into your strategy?  Check out our 200-level Online Course: Strategies for High-Value Health Care Purchasing to learn more.

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