Kim A. Jacobs is vice president of Strategic Business Development, Consumer Innovation and Commercial Strategy & Performance for UPMC Health Plan, which is part of the UPMC Insurance Services Division. The UPMC Insurance Services Division offers a full range of insurance programs and products and also includes: UPMC WorkPartners, UPMC for Life, UPMC for You, UPMC for Kids, Community Care Behavioral Health, LifeSolutions, EBenefit Solutions and Askesis Development Group.
In health care, price and quality transparency is quickly moving from an emerging trend to an expectation. When the cost of the same medical procedure can vary by more than 100 percent even within the same geographic region, consumers of health care understand that they need some kind of guidance.
Without access to good, solid cost and quality information, the modern health-care consumer pretty much is operating in the dark. Only through the use of transparency tools can a health-care consumer have the ability to make the best and most well-informed decisions.
The ideal transparency tool is one that makes price and quality information readily available for consumers, so they can easily read and compare. The need for both cost and quality information is necessary because there is not always a correlation between high costs and better healthcare quality.
Transparency Trending
Health-care trends suggest that there will be an increasing need for cost and quality information from health-care consumers in the years ahead. Because more health insurance plans require members to handle more of the up-front costs of care — through high deductibles and co-insurance — a lack of good, valid information could result in consumers paying much more for care that may actually be sub-standard.
Even though consumers do not literally “shop” for care as they might for other retail items, they are nonetheless entitled to having the kind of information that will enable them to select high-quality and affordable health care. Providing consumers with quality and cost transparency tools can give them the ability to do this.
By having easy access to consistent, accurate information about quality, price and service options when choosing a physician or health service, consumers will
be able to make more informed choices.
What should be understood, however, is that having access to transparency tools does not supplant the traditional role of the physician in any plan of care. Nothing can replace the invaluable knowledge of a patient’s health-care history that a primary physician has. For many, the convenience and comfort that is associated with working with a familiar physician cannot be overstated. Transparency tools do not replace a physician’s role; instead they can provide a way for patients to be educated in terms of cost and quality and give them information they can use to have a meaningful conversation with their physician.
How Effective Transparency Tools Work
Transparency tools are often powered by crowd-sourced data from consumers and physicians. What these tools can do is focus intelligence about a variety of conditions. For instance, the top treatments for persons with the same condition can be highlighted, as well as the most popular treatment chosen by other users of the tool.
With these tools, users can compare treatment options, learn about side effects, costs and typical patient preferences. These tools can also compare costs for the
same procedure at different facilities in the same region.
Transparency tools can serve as a way to educate patients in terms of cost and quality and they can use that knowledge to have a more informed conversation with their physicians.
When health-care consumers only learn the actual cost for a procedure at the time they get their bill, it can lead them to feel somehow cheated by the process. This adds to an erosion of trust in the health care system and could contribute to dissatisfaction with an employer that offers plans that do not include any form of transparency.
To learn more about the UPMC Health Plan transparency tools, visit http://www.upmchealthplan.com/healthyu/decision.html.
