The Healthcare Financial Management Association for several months has brought together leaders from all walks of the business (and I mean all) to try to sort through the morass that is health care price transparency.
Representatives of organizations that range from the American Hospital Association to America's Health Insurance Plans to the Leapfrog Group, with a patient thrown in for good measure, have been convening with the HFMA as a task force roughly every week for months, trying to solve the thorny issue.
Last week, the group released its recommendations and, while their suggestions aren't really revelatory, they're still a game changer, as HFMA CEO Joe Fifer puts it in the press release. That's because they're the product of a lot of folks who could never quite coalesce on this issue, but are now finally gelling.
"It's entirely reasonable for consumers to expect better access to price information," Fifer says in that release. "We are calling on all health care stakeholders to acknowledge that and to deliver the clear, reliable price information consumers are looking for. By achieving consensus about the roles all stakeholders should play, we have taken a giant step in the right direction."
Health insurers (and the government, too) have been tasked with the role of providing pricing details to patients who have coverage, as they are in the best position to do so. Plus, the task force underlines the need to provide other important tidbits to the patient before treatment, including whether a provider is in the health plan's network, the total out-of-pocket expense and details on the doc's outcomes and satisfaction scores.
Providers, hospitals and health systems, meanwhile, are assigned the duty of providing cost estimates to uninsured or out-of-network patients, according to the report. And transparent pricing information should be shared before service, paired with details on how complications or other unforeseen circumstances might affect the price tag, particulars of what is and isn't included in the stated price, and insight into the clinician's track record.
Beyond the payers and provider organizations, employers should assume a role in the equation, equipping their workers with transparency tools to help them select high-value clinicians. Referring docs, too, play a part, the report states, as they must help patients pick treatment plans that fit their situations, and assist them in locating docs who offer the highest-quality care at the lowest price. Authors also included a handy glossary of terms to help patients navigate through the sea of confusing terms that might show up on their bills or on transparency websites, many seemingly meaning the same thing ["charge," "cost" and "price" come to mind].
Of course, writing the report is one thing, but what are all these organizations doing to ensure that health plans and hospitals make these recommendations a reality? Richard Gundling, HFMA's vice president of health care financial practices, tells me that those involved have pledged to ensure that these practices are put to use, and task force members plan to stay connected to measure progress.
"Each of these associations is committed to getting this out and making sure their members are using it," Gundling says. "I think people are going to hold each other accountable. The thing about this multiorganizational task force is that each member can do that. It's about getting executive team and board support within each organization, and there are some recommendations in the report on how to get started."