Convened by the Healthcare Financial Management Association (HFMA), a task force made up of health plans, providers, consumers, employer groups, physician groups, and others has released guiding principles and recommendations for improving price transparency in health care.
The task force agreed that all Americans, regardless of their insurance status, should be able to receive accurate price estimates from a reliable source; that transparency should help people make meaningful price comparisons ahead of service; and that price estimates should be accompanied by other relevant information (e.g., quality, safety, or outcomes) that will help consumers assess the value of a healthcare service.
The key recommendations include:
1. Health plans are in the best position to help their members find out the total estimated price of the service.
- Health plans should help members estimate their expected out-of-pocket costs, based on their current deductible status along with copayment and coinsurance information.
- Health plans often have access to price information for many providers in a given region, which they can use to help members factor price into their decision-making process.
2. Hospitals should serve as a price information resource for uninsured people.
- Hospitals should continue to help uninsured patients identify alternatives for sharing their healthcare costs, including insurance options they may not be aware of.
- Hospitals should proactively communicate to all patients and community members—including the uninsured—that they may be eligible for financial assistance provided directly by the hospital. This financial assistance could mean that care is available for free or at a discount.
- Taking insurance eligibility and financial assistance into account, hospitals should offer uninsured people clear information on how to receive price estimates.
- All parties that provide price information should make clear to patients what services are and are not included in their estimates, and offer other relevant information, such as quality and safety data, where available.
3. Consumers should receive price information in an easy-to-understand format so they can make the most of the price information resources at their disposal. HFMA has developed Understanding Healthcare Prices: A Consumer Guide to help consumers get answers to their questions about healthcare prices.
4. Employers can play a role in price transparency by encouraging their employees to be engaged in their healthcare decisions.
View the full price transparency report.
Joe Fifer on improving price transparency
“People everywhere want to be smart healthcare consumers, but information about healthcare prices is not easily accessible,” said HFMA president and CEO Joseph J. Fifer, FHFMA, CPA, commenting on the price transparency report’s release. “For too long, it has been unclear how consumers should go about getting price information—who to ask, what to ask for, or what the information even means when they do receive it. This approach is a game changer.”