NQF Pricing Transparency Report
July 30, 2008 – 12:16 pm by ScottSchoenvogelhttp://www.qualityforum.org/pdf/news/IBPriceTransparency_6-page_Final.pdf
This is a good starter article for some basic information and sources for pricing transparency. Unfortunately, it glosses over a few major barriers that Compass has effectively solved for its customers:
1. “Retail” charges by providers are generally meaningless to patients with traditional insurance unless the insurance contract with the provider is based on a percentage of the “retail charge” – relatively few contracts have this structure
2. Aetna and United websites do not give true price comparisons as they simply try to set an expectation for what services might cost in a particular areas based on the average rate of their local contracts. Averages do not allow consumers to compare providers and make decisions. Aetna goes farther by posting some actual contract rates but it is only for small providers who do not have confidentiality clauses in their Aetna contracts.
3. Effective pricing transparency starts with the total contract rate and then is distilled into the patient portion. When making value based healthcare decisions it is always important to focus on the total cost of care. If the patient is not paying for the care, then the insurer or the employer is paying for it. Higher total care costs lead to higher premiums down the road.
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