Lessons Learned from Price Transparency Pioneers
“For price information to be meaningful to patients, it should focus on a patient’s financial obligation—what that individual is expected to pay—and not merely charges,” says HFMA President and CEO Joseph J. Fifer, FHFMA, CPA. This is a lesson that Fifer learned first-hand in his former role as vice president-hospital finance at Spectrum Health. In 2007, Spectrum was one of the first health systems to provide detailed out-of-pocket cost estimates to patients, in addition to posting gross charges and average payments on its website.
That same year, Alegent Creighton Health, a 10-hospital system based in Omaha, launched its MyCost online tool, which allows patients to obtain the estimated total cost—and their out-of-pocket responsibilities—for nearly 700 procedures.
These are the types of meaningful price transparency efforts that can gain the trust of consumers and help patients take greater charge of their healthcare purchasing decisions. Both of these goals have been advocated by HFMA’s Patient Friendly Billing® project for years.
Improving Cancer Care Value: UnitedHealthcare’s Episode-Based Payment Pilot
New cancer drugs, some of which cost $5,000 or more a month, may extend life only a few weeks; yet, current payment systems encourage their use. The UnitedHealthcare pilot, which started in 2010, seeks to escape the “buy-and-bill” system, which encourages oncologists to select the most expensive drugs and discourages the use of low-cost generics.
The pilot in five oncology practices uses an episode-of-care payment strategy for physicians. Each oncology group chooses the treatment regimen it wishes to use (e.g., a certain drug at a certain dose, additional drugs for side effects) for 19 specific cancer scenarios. The physicians then commit to at least 85 percent compliance with the chosen therapy.
ACO Pioneers Enter the Payer Market
Two of the first accredited accountable care organizations (ACOs) are collaborating with payers and employers to leverage quality and efficiency in health care. These large multispecialty group practices—Crystal Run Healthcare and Kelsey-Seybold Clinic—are tapping the employer self-insurance market to assist companies with rising costs as the Affordable Care Act expands coverage to more people.
Humanizing Health Care to Boost Patient Satisfaction
At Twin Rivers Regional Medical Center, nurses ask patients about their fears and concerns during the admission process. That human connection has helped Twin Rivers increase patient satisfaction scores by 33 percent last year. Added benefits: employee job satisfaction is on the rise and physician loyalty is increasing.
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