Consumers want more access to healthcare pricing information and more state governments are going online to give them at least some of it.
In October, MarylandHealthConnection.gov, the state’s online insurance marketplace, launched a new web portal that gave the approximately 150,000 residents who buy health coverage online the chance to comparison shop rates before open enrollment began Nov. 1 and during the enrollment process.
A new Colorado law in 2018 now requires hospitals to post online and by request provide some basic pricing data for patient out-of-pocket costs for the 50 most-used diagnosis group codes and the 25 most common procedural billing codes.
Florida also requires greater price transparency. Last year the Florida Agency for Health Care Administration awarded a multi-year $6.1 million contract to The Healthcare Cost Institute, a Washington, D.C., healthcare research and database services organization, to build an online pricing tools and services that will be added to FloridaHealthFinder.gov.
The first tool, FloridaHealthPriceFinder, lets users search an alphabetical list of about 300 common medical procedures. The tool lets consumers view “bundled” procedures, which are specific service, task, product or procedures bundled into one healthcare billing code. For example, the user can see what a hospital would charge for heart surgery and the cost of the stay, follow-up visits, the anesthesiologist and other costs.
The Healthcare Cost Institute built the FloridaHealthPriceFinder tool using claims data from the state’s Medicaid Managed Care program, which includes 49,000 healthcare facilities. Additional claims data came from Florida’s state employee group health plan. Over the next 12 months more data from the 14 major commercial health insurance companies that provide coverage in Florida will be added.
Florida residents spend a lot of money on healthcare—about $132 billion annually, the state says. But more price transparency is needed, a situation the Florida Agency for Health Care Administration says it’s looking to add through more self-service web tools.
“Floridians have already had the ability to use FloridaHealthFinder to access health plan report cards, locate the best facilities for their families and access educational resources,” agency secretary Justin Senior says. “FloridaHealthPriceFinder takes these resources a step further and gives consumers a more realistic cost estimate than was previously available.”
All states have a healthcare price transparency law that requires healthcare providers to disclose procedure prices—and the majority of those states have some type of public web site consumers can use to comparison shop.
But the quality of pricing information is poor and not useful in most states, says Catalyst for Payment Reform, a nonprofit corporation that researches healthcare purchases. Each year Catalyst for Payment Reform publishes a report card on the quality and quantity of state healthcare pricing transparency. For its 2017 grades 43 states received an “F” with Maine and New Hampshire the only states getting an “A.”
The criteria Catalyst for Payment Reform uses for grading include the timeliness and quality of pricing information.
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