HPCI News: Health Plan Transparency Metrics and Their Use by Consumers

To: Members and others

The Catalyze for Payment Reform's (CPR) 2013 National Scorecard on Payment Reform asked health plans about these transparency tools and consumer use. The health plan responses are as follows:

  • 98% of health plans offer or support a cost calculator
  • 77% of hospital choice tools have integrated a cost calculator
  • 77% of physician choice tools have integrated a cost calculator
  • 86% of plans report that cost information provided to members considers the member's benefit design relative to copays, cost sharing and coverage exceptions.

Only 2% of enrolls of these health plan used these tools in 2013. The CPR has issued a new report on price transparency tools: the good news, the challenges, and the way forward. Among the findings are:

  • health plan products need work before they meet the needs of consumers
  • consumers need help to understand value: high-quality care at the lowest cost
  • consumers need to understand their out-of-pocket costs, the full costs of their care, and why both matter
  • employers, purchasers, and consumers need to continue to push plans and providers so that those final hold-outs allow claims and other payment and price data to be shared unencumbered by gag clauses.

Information is not yet available on Iowa health plans.

The 2013 CPR membership included 32 employers and 8 Medicaid agencies and other public sector purchasers. Together they represent over 11 Million employees/covered lives and over $63 Billion in annual health care expenditures. For more information on the Catalyze for Payment Reform go to www.catalyzepaymentreform.org

Paul M. Pietzsch, MPH
HPCI - IHBA Office
4430 Ashley Park Drive
West Des Moines, Iowa 50265
(515) 778-6300

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