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

By Philip Betbeze  
   January 04, 2016

"Carolinas HealthCare System supports efforts across our industry that provide patients with useful and accurate information on quality, service, and cost," he says. "As transparency and estimation tools are developed, we advocate that comparisons are inclusive of the entire value spectrum. It can be misleading to patients if cost is the only attribute, especially if cost is not a reflection of what the patient will actually pay."

So far, says Mission Health President and CEO Ron Paulus, MD, the release of BCBSNC's prices paid list has not had a material impact on the health system, or on consumers, for that matter.

The recurring theme from patients who have reached out to the six-hospital health system based in Asheville, says Paulus, is that they don't how to interpret the information, that it's confusing and doesn't seem particularly relevant.

"We have spent some considerable time trying to explain to consumers, physicians, and others what the data mean, but truthfully, in its current form, the data don't mean much of relevance to a typical consumer who wants to know: 'What will I pay and what is the difference in clinical outcome and service quality that I can expect from my encounter?' " he says.

He adds that Mission Health fully supports the concept of reliable, actionable, informative pricing, service, and quality information for consumers, and says the health system has "numerous initiatives" underway in various states of development to support patient engagement and activation much more broadly.

"We know that patients [who] are more engaged in their care feel more empowered, have better clinical outcomes, and cost less," he says. "The open question is, how do we engage consumer-patients more effectively? We are working hard in this area but have a long way to go. We are committed to making the journey."

Does top leadership at hospitals and health systems need to worry about price transparency on a strategic level? In a word, yes, says Tomas Mikuckis, a principal in the health and life sciences division of consulting firm Oliver Wyman.

He says those who pay for patient care—patients themselves, employers, and the government—are moving quickly toward price and quality comparisons for services that are easily comparable, such as certain orthopedic procedures, colonoscopies, and, of course, imaging, to name a few. He calls those services highly transactional, and their prices are heading down.

Philip Betbeze is the senior leadership editor at HealthLeaders.

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