What you need to know about health care transparency tools

Price and quality transparency is more than just a trend in health care; it’s an expectation. With the cost of the same medical procedure varying sometimes by more than 100 percent even within the same region, the need for transparency by health care consumers could hardly be greater.

“Without having good, solid cost and quality information, the modern health care consumer is pretty much in the dark,” says Kim A. Jacobs, vice president of Strategic Business Development, Consumer Innovation, and Commercial Strategy and Performance for UPMC Health Plan. “Transparency is the future of health care and, as consumers, health plan members need the tools that help them make the best and most well-informed decisions.”

Smart Business spoke with Jacobs about how health care costs and quality can become more transparent for employees and how that can help drive down the high cost of health care.

What kind of information do health care consumers need?

Being able to manage both the quality and the cost of their health care is something that will enable consumers to make the best treatment decisions for themselves and their families. Ideally, you want them to have price and quality information readily available so they can easily read and compare. Having both cost and quality information is essential because, in health care, there is not always a correlation between higher costs and better health care quality.

Why has health care cost and quality transparency become an important topic?

Health care trends suggest that there will be an increasing need for cost and quality information from health care consumers in the years ahead. With health insurance plans requiring members to handle more of the upfront costs of care — through high deductibles and coinsurance — a lack of good, valid information could translate into them paying much more for care that may actually be substandard.

Consumers won’t be literally ‘shopping’ for care as they might for other retail items, but, just like retail consumers, they are entitled to information that enables them to select high-quality and affordable health care. Providing consumers with quality and cost transparency tools can give them the ability to do this.

By having easy access to consistent, accurate information about quality, price and service options when choosing a physician or health service, consumers will be able to make more informed choices.

Will transparency tools replace consultations with physicians?

No, not at all. It will always be important for families to talk with their physicians about any plan of care. The primary physician’s knowledge of a patient’s history is invaluable. In addition, the convenience and comfort connected with using a familiar physician cannot be discounted. Transparency tools can serve as a way to educate patients in terms of cost and quality, and they can use that knowledge to have a more informed conversation with their physicians.

How do effective transparency tools work?

Transparency tools are often powered by crowdsourced data from consumers and physicians. What these tools can do is focus intelligence about a variety of conditions. For instance, the top treatments for persons with the same condition can be highlighted, as well as the most popular treatment chosen by other users of the tool.

With these tools, users can compare treatment options, and learn about side effects, costs and typical patient preferences. These tools also can compare costs for the same procedure at different facilities in the same region.

How do these tools benefit employers?

Transparency tools support an employer’s efforts to encourage employees and families to make informed choices based on good information about quality and cost, including out-of-pocket costs.

When health care consumers are only able to learn the actual cost for a procedure at the time they get their bill, it can lead to them feeling somehow cheated by the process. This adds to an erosion of trust in the health care system and could contribute to dissatisfaction with an employer that offers plans that don’t include any form of transparency.

Insights Health Care is brought to you by UPMC Health Plan