A transparent view of health care Featured

8:00pm EDT September 25, 2007

Until recently, consumers needed a crystal ball to predict the cost of certain medical services. Charges for procedures like strep tests and X-rays were a great mystery — until the bill arrived. But why should consumers remain in the dark about something as important as the cost of their health care?

Having the right information is essential when purchasing health care. Consumers should have access to the same kind of objective cost and clinical quality information that is readily available when making any kind of significant purchase, such as buying a car, house or computer.

“Consumers are taking on an increasingly active role in the overall health care process,” said Bill Berenson, senior vice president of Aetna's Small and Middle Market Business for the North Central Region. “This presents an opportunity for employers, regulators and the medical community to work in collaboration toward a more transparent system.”

Smart Business spoke with Berenson about transparency in health care and the emerging technologies that are shedding a new light on cost and quality.

What is transparency?

Health care transparency is a variety of initiatives that help people make informed health care decisions based on a number of factors, including the actual costs of care and the clinical quality and efficiency of physicians. This kind of information was not previously available to consumers, but insurers now have a responsibility to give them the information they need to make well-informed decisions about their health care. Transparency is gaining momentum as a driving force in the health industry.

Do employees benefit from price information?

Employees can benefit in many ways, as they can now learn the cost of certain medical procedures upfront. An individual planning to see a new doctor can review charges for an office visit. Parents whose child is suffering from a sore throat can find out what they can expect to pay the pediatrician for a strep test. A family preparing for flu season could learn what it can expect to pay the doctor for a flu shot. Knowing actual rates can help your employees manage their annual out-of-pocket expenses and make better decisions about how to use their benefit plans.

What kind of technology is available to help consumers gather price information?

Online tools can give consumers easy access to actual rates negotiated with doctors for the most frequently performed treatments and services. Personal Health Records (PHRs) provide online access to personal health information, including drug prescriptions, medical tests, individualized personal messages, alerts and a detailed health history that can be printed and shared with physicians. Still other tools can provide information about hospitals according to specific diagnoses and procedures, such as the number of patients treated per year, complication rates, mortality rates and length of stay. This information can help consumers decide where to access care. Integrating information and resources helps patients and their physicians make more informed decisions and better manage their health and health-related expenses.

How does transparency impact employers?

Transparency may have its biggest impact on employers as they shift toward consumer-directed plans. Giving people credible, easy-to-understand information is an essential part of the consumer-directed movement. Transparency not only provides this kind of information; it also demonstrates the insurer’s commitment to both the employer and its employees.

What’s next?

Price transparency is only the beginning. Patients need enough information to make decisions based on overall value, not simply price alone. Transparency efforts are expanding to provide consumers with information on quality as well as cost efficiency. The health-related choices we make for our families and ourselves are too important to make in the dark.

BILL BERENSON is senior vice president of Aetna’s Small and Middle Market Business for the North Central Region. Reach him at (312) 928-3323 or berensonw@aetna.com.