Clare Krusing

The push to greater transparency across the health system hit the fast-track at the end of 2019 with the Trump Administration unveiling its latest proposal that would require greater disclosure of negotiated prices between health plans and hospitals. While the Administration’s plan represents a bold change in publicizing negotiated rates, it also underscores a prevailing tension around the type and amount of health pricing data that should be disclosed.

The ultimate question – will it make a difference for consumers?

The vast majority of patients generally aren’t up for the challenge of price-shopping for their care, according to recent studies highlighted in the Los Angeles Times. Even for those with a high-deductible health plan – the patients with the most “skin in the game” when it comes to paying upfront for medical services – rarely sought out price information for their care. Instead of embracing the plethora of online pricing tools in the market, patients continued to rely on their doctors and physicians to provide the best direction about their health.

Some argue transparency for the sake of transparency is just the right prescription to fix the ailments and misaligned incentives in our health system today. No doubt the growing affordability challenge from surprise medical billing is the latest example of the harmful, opaque pricing trend that poses a real threat to consumers. But going too far down the transparency path can put consumers at a disadvantage if health care prices go up as a result.

As the Administration and the health system embarks on a new era of transparency, there are some key questions to consider:

How much pricing data can be provided in real-time? The one-click wonder of online shopping has made pricing comparisons between competing retailers a relative breeze. We can get real-time price updates on everything from plane tickets to groceries and lots in between. Getting real-time data on health care prices? That’s a whole different story. A big question for stakeholders will come down to timing relevancy – is 2018 or 2019 pricing data helpful for patients? What is realistic in terms of real-time pricing data that can inform actual health care choices?

What type of data is most meaningful – and useful – for patients? Let’s face it – a big excel sheet of wholesale prices and CPT codes is useful for researchers and academics, but for consumers? Not so much. A big question mark on the push towards greater transparency is how much and what specific data can be translated into direct consumer use, either through updated and innovative apps or to inform new benefits?

What integration and coordination is required between key players in the health system? A key lesson learned from the roll-out of enhanced provider directories is that data-sharing capabilities between doctors, hospitals, pharmacies and health plans vary drastically. If pricing transparency is about aligning incentives in the best interest of consumers, what are the back-end infrastructure and technology needs that need to be prioritized moving forward? This is particularly critical for rural communities where wireless capabilities are still limited and electronic health records aren’t the norm.

Greater transparency can be a starting point for fixing some of the longstanding barriers to better care and better value in our health system, but only if the end consumer is in mind.