Improving Transparency in Healthcare Pricing

Improving Transparency in Healthcare Pricing

West Health is continuing its efforts by focusing the 2019 Summit on three key areas of interest: lowering drug costs, enacting value-based care over fee-for-service models, and price transparency.

Improving Transparency in Healthcare Pricing

Greater transparency is essential to making healthcare decisions based on value. Today, most patients do not have access to information about the actual cost of a medical service, whether it is a medication, hospitalization, test or surgery, making it difficult for them to become informed consumers of healthcare, and nearly impossible for them to get a fair deal on their terms. Most patients also have no way of knowing whether recommended services are genuinely needed or whether there are potential alternatives. Creating a healthcare marketplace that is fully transparent will enable patients to make care decisions that are best for them and their families, and will ensure employers, health plans, and providers have sufficient information to purchase and design care that improves value.

Transparency proposals include: Expand availability of information and build knowledge.

We need to expand the opportunities and information available for shared decision-making based on clear understanding of potential benefits and risks. To create a more effective and empathetic cost-of-care landscape, the healthcare system in the U.S. should make cost information available up front and provide practical shared decision support tools. Key to this process will be unshackling healthcare data for payers, and encouraging providers and health systems to publish prices for patients to consider these factors as part of their care decisions. By improving transparency, we can create opportunities to empower patients and payers with information, so they can choose lower cost, higher value care

Scale successful models with flexibility.

Stakeholders should begin scaling models that work, and build enough flexibility so the models can be adapted to be successful across communities and healthcare settings. This involves creating mechanisms to learn from high-performing systems and creating training programs for providers and healthcare executives, as well as collaborative opportunities to share best practices. In transforming the delivery of healthcare, providers and systems must have a seat at the table to determine how best to become efficient producers of valued care, with approaches that work in their systems and communities.

Increase the diffusion of innovation.

New, more effective technologies that can improve care at lower costs are quickly coming to the market. To take advantage of these technologies, patients and payers should have available information to understand when new technology is appropriate and of high value. Stakeholders should also promote enabling technologies that help patients engage in self-care and communicate more effectively with their providers. A patient’s ability to furnish his or her provider with pertinent information could avoid unnecessary and costly care. At the same time, we should resist the rush toward technologies that are new but offer no—or limited—advantages, and come with a higher price tag.

Healthcare Costs Innovation Summit

The rising cost of healthcare is a growing and major threat to our economy, our financial security and our individual health. For too long, we’ve been paying too much and not getting enough in return. The U.S. healthcare system is on an unsustainable cost trajectory. We have an urgent need to address this cost crisis so that healthcare can become more accessible and more affordable for all Americans. Now is the time.

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