Skin in the game is my least favorite popular vernacular to come out of the ongoing health care debate. I cringe when some policy debater declares that costs will never be controlled until consumers experience greater cost sharing, which will cause them to shop around for the best deal.

First, consumers have plenty of skin in this game. Personal bankruptcy, exclusions for pre-existing conditions, lifetime limits on coverage, medical emergencies —among many others — all have serious consequences for individuals with the misfortune to fall into one or more of these circumstances.

Second, where are consumers supposed to find all this information that will turn them into price-sensitive savvy health care shoppers? A full-blown crusade
of consumers on a passionate mission to comparison shop health care prices would essentially have nowhere to go.

Obviously, those consumers lucky enough to have insurance have been shielded from price variables. That is, after all, one of the main points of having insurance so that individuals are not financially affected by the cost of an episode of care. But, as many hospital executives know, that is changing.

The fastest growing type of health insurance benefit design is the high deductible health plan. As of January 2013, insurance researchers say that nearly 15.5 million consumers were covered by such a plan, and that number is climbing quickly and shows no signs of slowing down. You are well aware of this trend because you have watched it build at your hospital over the last several years.

As consumers shoulder more of the cost of care, the movement toward price transparency will gain more and more momentum. Price transparency in health care is not a simple matter. Many variables exist that can and will affect a price and the quality of information provided to a consumer. But transparency is also a movement that can't be denied. It is going to happen.

Employers, insurance companies, and private organizations and companies are developing "tools" to facilitate the process. No doubt some are more useful than others and offer more than just the price of a service or procedure and include quality and experience information as well for a more informed choice. One of the better-known companies in this space is Castlight Health, which provides employers a transparency platform that incorporates multiple sources of information about cost, quality metrics and other variables. Independent companies such as Fair Health Consumer, Healthcare Blue Book and New Choice Health deal online directly with consumers.

Last month, Aetna, UnitedHealthcare and Humana turned many heads when they announced that they will partner with a nonprofit organization to share information about prices and quality via an online portal. The Health Care Costs Institute says the portal will be free to consumers and up and running in January of 2015. Cost data will be supplemented with quality of care data. HCCI officials claim that they hold data on 25 percent of the entire insurance market under age 65.

Transparency may be far from being a functional reality, but in the private sector it is clearly on the march.

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