Focus on Value
The impact of price transparency and quality on patients’ care decisions
By Pamela J. Gallagher
The federal government has introduced price transparency policies in hopes that consumers will be able to compare services and receive quality care that won’t break the bank. But not enough has been done to equip consumers to determine the overall value of the care they receive.
Understanding the out-of-pocket cost is essential for patients to make informed healthcare decisions. However, I believe patients need more than pricing data. They need to be equipped with information that takes into account other essential factors when making healthcare decisions that can affect the cost of their care over time.
Quality of care
As the healthcare industry moves toward pricing transparency, metrics on the quality of a given facility or service becomes especially important. After all, in seeking out pricing information, what patients are truly seeking to discern is the value of a given medical service—and quality of care is a fundamental component of understanding value and for the consumer’s long-term health.
While most experts agree that consumers need quality data alongside price information to make wise care decisions, only two-thirds of plans shared provider performance data with members, with just half of those integrating quality data into their price-estimator tool, according to a 2016 study in the American Journal of Managed Care.
In addition to moves toward packaging cost and quality information together, hospitals need to gain an understanding of what the consumer views as “quality” while educating consumers on how quality ratings are determined within the hospital. Additionally, a shift toward real pricing compared with the chargemaster will give consumers a clearer picture of the cost, which will allow them to more accurately weigh the value of a service.
An overemphasis on the cost of care has the potential to create a situation where a patient forgoes quality care to gain short term savings, but ends up driving up the cost of their care in the long term by repeatedly sacrificing quality. It is crucial that information on the quality of doctors, facilities, services, etc., be provided as transparently as pricing information so that consumers, in partnership with their physicians, can make value-based healthcare decisions that will be wise for their long-term physical and financial health.
Resources:
Why Healthcare Needs Price Transparency and Better Technology, RevCycle Intelligence
Will Price Transparency in Health Care Lower Costs or Backfire?, University of Pennsylvania
Our take: The 3 big critiques of Medicare’s move toward price transparency, Advisory Board
Achieving Transparency in Healthcare, Modern Healthcare