Beyond Price Transparency

Price Transparency. These two health industry buzzwords convey the need to empower patients with simple and precise information about the cost of healthcare. Boiling down the complex healthcare pricing systems into patient-understandable terms prior to care is a critical step to enabling the patient to understand how much money they will owe after treatment and determining how they will pay their portion of financial responsibility. Furthermore, providing the costs of treatment prior to care gives the consumer an opportunity to shop for alternative care and figure out how their financial responsibility will be paid. While today’s patient financial responsibility estimation technology achieves price transparency by emulating the claim adjudication process, future enhancements will provide even more actionable information. Building on a foundation of treatment cost estimates, transparency also needs to incorporate facets of quality based on physician credentialing, patient safety, and healthcare outcomes. As these two components come together they will represent a fundamental driver to a successful consumer based market for healthcare.

In this evolved market, before seeing a primary care provider or a specialist, patients will be able to compare the credentials and quality metrics of providers in their area and across the country in conjunction with the price of their services. Credentials offer subjective evidence to understand the physician’s specialized training and to impart confidence in their ability to provide high-quality treatment by acknowledging where they were trained. Similarly, credentials will include board certification when a physician attains a higher degree of education and disciplinary actions when the physician is censured by an affiliated hospital, various medical boards, or indicted for criminal convictions. Information such as how many procedures of a given type the physician has performed will build on this theme of experience and add perspective to healthcare decision making. How much do you know about the physicians you see? Exposing physician credentials opens the door to information that will enable patients to compare quality.

Patient safety is another facet of quality transparency. Exposing comparable patient safety measurements will enable patients to understand the relative safety of one healthcare provider versus another. Imagine being able to compare the medication administration safety and infection rates of regional hospitals. Is the provider using Computerized Physician Order Entry to reduce the likelihood of prescribing errors? Does the nursing staff have access to systems that prevent medication administration errors? How many infections were caused in the last year within the hospital? Contrasting patient safety trends with those of similar providers provides information to the patient that has never been available before. Evaluating quality factors such as these increases transparency and helps patients assess where to get treatment.

New transparency tools will also enable patients to understand the outcomes expected with certain types of treatments and procedures. Outcomes will likely be demonstrated through standardized, evidence-based measurements and allow you to recognize the relative effectiveness of the types of treatments used by a particular physician. Instead of blindly accepting that a single clinical course of action exists for a given diagnosis, outcome comparison will demonstrate the comparative benefits of a treatment or procedure provided by one doctor versus the others available. The healthcare industry is dynamic and always striving for better quality, and making outcomes more transparent will spur competition leading the industry to even more breakthrough improvements.

Even after these quality transparency tools are readily available, price will very likely still play one of the largest factors. One hallmark of our society is that quality often costs more. A provider that develops strong credentials, keeps an excellent safety record, and achieves effective outcomes for patients will likely cost more than an average quality provider or one with a few blemishes on record. The ability to accurately estimate healthcare costs will be viewed in light of provider quality, and healthcare decisions will be able to undergo scrutiny with factual, comparative information. Providing transparent price and quality information prior to care will foster competition and lead to higher quality services at ever-competitive prices. As the healthcare industry continues to develop capabilities that enable more pre-care transparency, our aim should be far beyond displaying patient cost estimates and consider the quality aspect of the providers we pay.

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