October 20, 2020
Access to information about the quality and costs of health care services and providers can help consumers make more informed choices about their care; help payers build better provider networks, plan designs, and derive more value for their health care spend; and let providers know the costs of the care they provide and prescribe.
CMS has a trove of data on price and quality from hospitals, physicians, and other providers. Much of this data is increasingly being made publicly available. The marketplace, through employer, health plan, private organizations, and other efforts is also generating similar data and tools. This information helps patients and payers, including employer plans, identify efficient providers who deliver higher quality care and better outcomes.
- Patients and payers have the right to know out-of-pocket prices and prices for services within their plan. They should also be able to compare quality for these services;
- Patients and payers have the right to know which physicians and systems are providing higher quality care, as well as those that are not;
- Health care providers, suppliers and facilities should disclose in a patient-friendly format all relevant information about prices and quality for clinical services, prescription options as well as alternative options for care;
- CMS should require transparency of prices across all settings and provider types including facility fees for hospital-owned physician services and rates for out-of-network services at in-network facilities;
- HHS should continue to support efforts to streamline core measures of quality, outcomes, cost, efficiency and efficacy, balancing provider administrative burden with the provision of meaningful information to patients and payers; and
- HHS should continue to improve the methodology for reporting quality measures to enhance predictability and comparability.
Why It Matters
- As health care costs continue to rise, outpacing overall economic and wage growth, demand for price and quality 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.
- Transparency helps people better understand the true costs of care and discern the relationship between quality and price and seek out alternatives if necessary.