Comparing Costs

Consumerism and Healthcare Price Transparency: How Can Patients Compare Costs?

When was the last time you made a significant purchase, sight unseen? If you’re anything like me, you probably can’t remember. Nowadays, there’s an online review for nearly every type of product. Don’t believe me? Just look at big publications like IGN running review articles on fidget spinners. Yes, fidget spinners.

The age of consumerism has arrived, and already we can see it creeping into the healthcare industry. With shifting government regulations and rises in both premiums and deductibles, many consumers of healthcare have begun to take their well-honed savvy-shopping skills and apply them to the care they receive. Many of these smart shoppers have run into something of a brick wall. While consumer products and services in other markets are rife with insight into cost and quality, healthcare—as it is in a lot of areas—is late to the game.

When my wife came down with a head cold early this week and we suspected it might be strep throat, our doctor shopping quickly led her to ask, “Does the doctor’s office even know how much a visit will cost?” In some cases, the answer is actually, “Not really.” I spoke earlier this week to the CFO of a rural, critical access hospital. When I asked him how he measures the total cost of care for his facility, he said he tracks most things in-house using an Excel spreadsheet.

I spoke to another organization looking at upgrading their EMR, moving from a smaller vendor to what they called an “umbrella system,” and one of the key, must-have items for that organization is an accounting piece that would allow them to track their cost of care. There are many providers in the same boat who have to find creative solutions to determining, tracking, and managing their costs.

There are similar difficulties on the payer side of healthcare. Last year, KLAS took a preliminary look at the price transparency market and found that, ironically enough, transparency was lacking in the price transparency market. In the Healthcare Price Transparency Solutions 2016 report, we discovered that many payers lacked open lines of communication and true partnerships with their price transparency vendors.

While there are many things to point to as obstacles to be overcome, we’re hopeful that there are creative solutions. For example, it’s not natural for people to think of their health plan as the first place to turn for help when navigating healthcare. But it is in a health plan’s best interests to play a proactive role in the care of their members. As we see more of a convergence in the roles of provider and payer (or “payvider,” the term we use), we’re seeing a dual-pronged, concerted effort to help combat rising healthcare costs among the shifting sands of government legislation.

 Payer Chart

For example, the process for finding my wife a new, in-network physician was incredibly easy. Our health plan is owned by a large IDN, and that made it simple to understand which doctors, urgent care facilities, and hospitals were in-network. In addition, our health plan regularly sends reminders about necessary preventive care in concert with the reminders from our general practitioner.

Solutions such as these, combined with innovations in the healthcare IT world, may go a long way toward both satisfying the consumerism of healthcare and helping providers and payers alike navigate the costs of care.