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Analysis

Transparency Is Difficult

By John Commins  
   October 23, 2019

Clinicians confront the logistical challenges of providing consumers with accurate, understandable data.

This article appears in the September/October 2019 edition of HealthLeaders magazine. It is a sidebar to the cover story, "Price Transparency Is Coming. How Will You Prepare?"

Beyond the fears that public disclosure of negotiated rates could harm payers and providers, a reason why price transparency is lagging in healthcare is because "it's hard to do," says Suzanne Delbanco, PhD, executive director of Catalyst for Payment Reform.

"There are some logistical challenes to getting the information to people in a way that is accurate, understandable, and relevant," she says. "While health insurance companies themselves have gotten much better with the tools that they offer, there's still a lot of missing data; the functionality is still clunkier than it should be. We still have a way to go in terms of figuring out how to do it."

Related: Price Transparency Is Coming. How Will You Prepare?

Kari Cornicelli, CFO at Phoenix Children's Hospital, says the pediatric provider works closely with patients' families to give them as accurate a cost estimate as possible, but challenges remain.

"If you're paying the bill, you want to understand what you're paying for, but when there are complexities related to a very difficult diagnosis, the care is going to change depending on how the patient reacts to each phase of care," Cornicelli says. "So, it's really hard to give solid out-of-pocket costs to the family."

"Many times, the family doesn't really fully understand the complexities of their care," she says. "Therefore, when they ask for pricing, and we give it for what we think they're getting, and then their services are actually different, that's where it becomes more challenging."

"We're really focused in on what is the difference between what they're going to be responsible for," she says. "We don't want to go into the whole complexity of their insurance product. We want to get back down to identifying what their copay or their deductible is going to be."

“It's really hard to give solid out-of-pocket costs to the family.”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

Photo credit: Kari Cornicelli is CFO at Phoenix Children’s Hospital in Phoenix, Arizona (Mark Peterman/Getty Images)


KEY TAKEAWAYS

Payers have gotten better with the tools that they offer, but there's still a lot of missing data.

Patients and their families want to understand what they're paying for, but when there are complexities related to a difficult diagnosis, the care is going to change.


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