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

By Philip Betbeze  
   January 04, 2016

The release of the price data has caused some pushback from providers in the state, Caveney says, but he adds that most health plans have been making this information available to premium-paying members prior to last January's release. Individuals in the general public shopping for health plans under the Patient Protection and Affordable Care Act exchanges, however, had very little such knowledge.

"We thought that releasing this data to the general public could educate them," Caveney says. "It's relevant to know not only whether a particular site of care is in network but also to know about the potential costs potential buyers might incur if they bought these services and went to those providers."

The decision surprised many hospital and health system executives in the state, among them Linda Butler, MD, vice president of medical affairs and chief medical officer at Raleigh-based Rex Healthcare, a member of UNC Health Care, which reported net patient service revenue of $2.35 billion in 2013.

"It's relevant to know not only whether a particular site of care is in network but also to know about the potential costs potential buyers might incur if they bought these services and went to those providers."

Butler, who had no advance notice of the disclosure, told HealthLeaders Media earlier this year that the numbers can be misleading and don't always present the complete picture of what goes into the price listed. For instance, a search for colonoscopies will list prices, but the procedures have different CPT codes. "Giving you a defined price is much more complex than just giving you a range, and sicker patients will cost more," she says.

Spencer Lilly, president of the 874-bed Carolinas Medical Center in Charlotte, the flagship hospital of Carolinas HealthCare System, where he is also senior vice president, says he has yet to see any material change in patient volumes in the Carolinas marketplace that are directly associated with Blue Cross's efforts in this area, but he is concerned that patients may not be getting a full picture of the value of their care if cost is their only consideration.

Philip Betbeze is the senior leadership editor at HealthLeaders.

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