(ARA) - Imagine a world without price tags. You can make a purchase, but you’ll have no idea of the charges until the bill comes in the mail.

Until recently, that’s the world that the average American lived in when seeking health care. As part of a health care system that shielded insured patients from the actual costs of care, most Americans with health insurance never questioned the care that they received or its cost. Today’s consumers, however, are being asked to take on greater financial responsibility for their health care and a more active role in making decisions about the care they receive.

In response, says Charles Cutler, M.D., a national medical director with Aetna, consumers are beginning to question cost and quality, and seek tools and information to help them make informed decisions. The movement towards providing this information to consumers is widely known as health care “transparency.”

“The increase in costs has made it very important for consumers to understand what their expenses are going to be and the level of quality they can expect to receive, which helps them determine how to get the most value for their health care dollar,” says Dr. Cutler.

Research points to this increased interest and involvement, and the need for transparent information on health care costs and quality. A study released in the spring by the Council for Affordable Health Insurance found that 84 percent of Americans agree that health care providers should publish their prices for all goods and services.

The good news for consumers is that both public and private organizations – including the federal government, health insurers, employer coalitions, and state agencies – have begun to respond by offering transparent price and quality information.

The Centers for Medicare and Medicaid Services (CMS) helped lead the way this summer when it posted its payment rates for approximately 30 elective inpatient hospital procedures and other common hospital admissions. CMS also provides some quality information on hospitals at its website.

Similarly, insurers are providing new levels of detail about the health care providers that participate in their networks. In most cases, average pricing information is provided – for example, the average cost of an office visit or strep test within a certain zip code. Quality information is also becoming increasingly available through insurer Web sites.

According to Dr. Cutler, Aetna is taking the level of detail one step further. Aetna was the first health plan in the nation to offer its members online access to physician-specific cost and quality information. This means that Aetna members can go online and research the price tag for care from their specific physician, as well as see indicators related to the use of proven preventive interventions, adverse events and hospital readmissions, before their next appointment.

“Our focus is on providing information that is relevant to our members,” says Dr. Cutler. “While we don’t expect anyone to make decisions based on this data alone, we do hope to move the health care marketplace closer to providing the kind of detailed cost and quality information that we all access when making any other major purchase.

“After all,” he adds, “there are few purchases in life that are more important than quality health care.”

Recently, President Bush gave a significant boost to the transparency movement with the signing of an executive order. Signed in late August, it directs federal agencies that administer or sponsor federal health insurance programs to increase transparency in pricing and quality, encourage adoption of health information technology standards, and provide options that promote quality and efficiency. The President is also asking state governments, large unions and large employers to commit to these same criteria in purchasing health care for their employees and members.

Aetna’s physician-specific price and clinical quality information is available for physicians in all or parts of 11 states and the District of Columbia. Dr. Cutler says the company has plans to expand the program further. The information is available to members on the password-protected section of Aetna’s Web site (accessible at www.aetna.com).

Interested in doing a little research before your next trip to the doctor or hospital? Dr. Cutler suggests logging on to your health plan’s Web site to see what resources are provided there. Consumers can also access hospital cost and quality information at www.Medicare.gov. And, once you’re at the doctor’s office, Dr. Cutler encourages consumers to talk to their physicians about both health care quality and costs.

Courtesy of ARA Content

Trackback URI | Comments RSS