Because health plans will in most instances have the most accurate data on prices for their members, HFMA’s Price Transparency Task Force recommends that health plans serve as the principal source of price information for their members.
Many health plans have already developed or are in the process of developing web-based or telephonic transparency tools for their members. There are also a growing number of independent vendors that use data from health plans and/or employers in web-based tools and telephonic products to inform employees about price.
These tools have the potential to benefit both patients and health plans, providing patients with needed information while strengthening the health plan’s value to its members. Employers with self-funded health plans have the option of working with health plans (which often serve as third-party administrators for self-funded plans) or other vendors in developing transparency tools for insured employees and their dependents.
Transparency tools for insured patients should include some essential elements of price information, including:
- The total estimated price of the service
- A clear indication of whether a particular provider is in the health plan’s network and information on where the patient can try to locate a network provider
- A clear statement of the patient’s estimated out-of-pocket payment responsibility
- Other relevant information related to the provider or the specific service sought (e.g., clinical outcomes, patient safety, or patient satisfaction scores)
To provide the most helpful price information, these tools should be tied to the specifics of an individual’s benefit design and include information on applicable copayment, coinsurance, or deductible requirements. They should also assist members in identifying in-network providers and identify any impact that selection of an out-of-network provider is expected to have on the patient’s responsibility for payment. Both health plans and providers should alert patients to the need to seek price information from out-of-network providers.
Read the full report, Price Transparency in Health Care: Report from the HFMA Price Transparency Task Force (PDF format).
