Access to information about the price and quality of health care services can help consumers make better and more informed choices about their care; can help payers build better provider networks, plan designs, and provide more value for their health care spend; and can give key information to providers wanting to know the costs to their patients and those wanting take on more financial risk in alternative delivery models.
- Patients and payers have the right to know out-of-pocket prices and plan prices for services.
- Health care providers, suppliers and facilities should disclose in a patient-friendly format all relevant information about prices and quality for clinical services and alternative options for care.
- CMS should require transparency of prices between freestanding, hospital outpatient and inpatient settings; facility fees for hospital-owned physician services and disclose out-of-network services and prices at in-network facilities
- HHS should continue to support efforts to streamline core measure sets of quality outcomes, cost, efficiency and efficacy, with the aim of balancing reducing provider administrative burden with providing meaningful information to patients and payers.
WHY IT MATTERS
- As employers increasingly offer high-deductible health plan options to employees, demand for transparency information related to true out-of-pocket expenses and for quality and cost information has never been higher.
- Better information on price and quality are also critical to building better provider networks and alternative delivery models. They are also important for providers who want to take on more financial risk and can influence provider decisions once they know the costs of care for their patients.
Improving transparency is not “the only goal,” but is a means toward multiple goals including helping patients avoid sticker shock, facilitating shopping, lifting the veil on high prices, and ultimately making care more affordable.
Also of Interest