In the past, health care was a limited service that employers provided employees.
The service was limited because there was only coverage for certain physicians, medical
procedures and prescriptions, depending on
the plan.
Today, health care plans, such as Health
Savings Plans, give consumers more choices
in health care service. For many consumers,
more choices lead to confusion and the need
for knowledge to make educated decisions.
Health care providers advertise their plans as
being transparent to ease consumer fears,
but it is important for consumers to truly
understand the information they are being
provided and how to use such information.
The benefit of transparency is that when
consumers are armed with information on
quality and price, they can make better decisions, according to Sally Stephens, president
of Spectrum Health Systems. Transparency
is an initiative enabling consumers to compare the quality and price of health care services, so they can make informed choices
among doctors and hospitals.
Smart Business spoke with Stephens
about transparency, how consumers should
utilize this tool and how it is affecting the
health care industry.
What is health care transparency?
Today, transparency simply means the
publication of provider charges. However,
true transparency only occurs when patients
understand their out-of-pocket expenses,
not just provider charges.
Numerous influential organizations, including the Healthcare Financial Management Association, various state hospital
associations, the American Hospital Association and the U.S. government, have come
together advocating patient consumerism by
trying to answer some very difficult questions regarding transparency in the health
care industry.
Some of America’s largest employers and
the medical profession are cooperating to
lay the foundation for pooling and analyzing
information about purchasers, hospitals and
physician services. When this data system is
in place, the regional health information
alliances will turn the raw data into useful
and meaningful information for consumers.
How do consumers utilize this tool?
The true purpose of full health care transparency is to provide the consumer with
information on quality of care and cost. This
tool will allow them to obtain the information
that can assist them in making an informed
decision regarding the appropriate level of
care that is right for them. And, the responsibility will be on the consumer to make sure
they access a credible source for this information. After all, this is how consumers purchase any other service or product they buy.
How can this tool benefit a consumer’s overall health care?
Consumers deserve to know the quality
and cost of their health care. Transparency
provides them with the information necessary and the incentive to choose health care
providers based on value. Consumer choice
creates incentives on all levels and motivates
the entire system to provide better care for
less money. Improvements will come as
providers can see how their practice compares to others.
Can there be total or true transparency?
The concept of health care transparency is
a noble idea. However, the transition from concept to reality creates significant challenges. Complete display of charges is meaningful to self-pay patients, which only represents 5 percent of the average consumers.
For the vast majority of patients to understand consumerism, they need to understand
the unique relationships between the entities
or the contracts, charges and benefits. So, to
achieve true transparency and empower
providers and patients to work together, payors need to provide better access to tools that
allow ready access to their contracts and
charges. This will allow them to better determine how a procedure will be paid; therefore,
integration of contracts, charges and benefits
provides all the necessary information for
patients to become educated consumers.
Are there risks on solely relying on transparency when selecting a health care plan
and/or provider?
Giving consumers the information and
decision-support tools they need is much
more complex than just comparing prices. In
fact, introducing transparency depends on a
convoluted set of circumstances and challenges. For example, physician fees for a specific service or procedure have little relationship to the total cost of care. Therefore, the
total costs associated with an entire episode
of care would be more relevant. Currently,
cost-of-care measurements are unavailable.
How does transparency affect the relationship between providers and employers?
The goal is that transparency enhances the
relationship with doctors and patients.
Patient inclusion improves care and can help
move us from episodic intervention to a
model of chronic care management that
rewards keeping people healthy. Data exposure will lead to patient empowerment.
Empowerment results in an increased
demand for evidence-based medicine
because it demonstrates effectiveness and
improves quality of care. And, quality of care
means lower costs.
SALLY STEPHENS is president of Spectrum Health Systems. Reach her at [email protected].
