Big Ideas: Healthcare Price Transparency: Patients and Payers Versus Providers?

Philip Betbeze, January 4, 2016

Healthcare Price Transparency: Patients and Payers Versus Providers?

The release of the price data by Blue Cross Blue Shield of North Carolina has caused some pushback from providers in the state.

This article first appeared in the December 2015 issue of HealthLeaders magazine.

Healthcare price transparency is a laudable concept. Patients want it because they are contributing a larger share of the cost of care each year, through larger deductibles and larger out-of of-pocket maximums. The stumbling block for providers is that accurate pricing of healthcare services is nearly nonexistent. Provider organizations negotiate prices with payers, but one side often has a disproportionate influence, and what individual patients pay depends on their insurance.

Now, however, a payer is forcing the issue in a way that puts hospitals and health systems on the defensive.

"Lots of different stakeholders are demanding we produce more transparent information."

Blue Cross Blue Shield of North Carolina made news earlier this year when it decided, like the Centers for Medicare & Medicaid Services before it, to publish prices it pays to specific sites of care for specific procedures.

"Lots of different stakeholders are demanding we produce more transparent information," says Brian Caveney, MD, JD, MPH, vice president and senior medical director at BCBSNC. "Certainly the employer group insurance market is still big and important, so employer groups and their benefit consultants are particularly vocal about wanting information about where they should be steering their employees, and they're expecting the health plans to do that not only through benefit design but also through price transparency."

Philip Betbeze

Philip Betbeze is the senior leadership editor at HealthLeaders Media.

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