A Texas Approach to Health Cost Transparency
FOR IMMEDIATE RELEASE
July 1, 2014
CONTACT: Darrell Farr, 512-476-2091
A Texas Approach to Health Cost Transparency There have been a lot of conversations this interim about Texas' efforts to make health care pricing more transparent. While most of the talk centered around the topic of the Affordable Care Act or "Obamacare" and the challenges it still faces, the follow-up subject was always how to enhance health care price transparency in the state.
Heath plans endorse the concept of price transparency. At the federal and state level, the issue is nonpartisan. Policymakers have enacted price transparency regulations in over thirty states during the past decade in an attempt raise consumer awareness about the costs of their care.
On the federal level, the Centers for Medicare and Medicaid Services (CMS) launched a new health care literacy initiative – “From Coverage to Care” (C2C) – that provides resources, including written materials and videos to help people with new health care coverage understand their benefits and connect to primary care and the preventive services that are right for them. Included among the new resources is a document entitled “A Roadmap to Better Care and a Healthier You.” This federal initiative follows a three part initiative developed by the Department of Health and Human Services (HHS) and CMS that for the first time gives consumers detailed information on what hospitals charge. The data posted on CMS’s website include information comparing the charges and the widely varying actual payments for services that may be provided during the 100 most common Medicare inpatient stays.
At the state level, "All Payers Claims Databases" are gaining some traction with mixed results. In most cases they are difficult to navigate and understand, resource intensive and lack supporting clinical data needed to give an accurate picture of the value of a physician's or hospital's service. During the recent National Summit on Health Care Price, Cost and Quality Transparency, America's Health Insurance Plans stated, "Releasing large amounts of such data without considering the competitive dynamics could actually have the opposite effect that we're trying to achieve and probably drive prices higher."
Today, Texas is reviewing the way it provides health care price information in an accessible way. In 2007, the Legislature passed S.B. 1731 providing for increased transparency in health care pricing. The law, among the most comprehensive in the country, promotes fair pricing in the health care industry, it created a "Consumer Guide to Health Care" and has begun posting inpatient data and outcomes from providers and plans.
S.B. 1731, provides Texas the tools to recognize consistent billing policies and inform patients about the potentially high costs of out-of-network providers, further, the law requires a data reporting program to collect health plans' paid claims data from different service areas across the state to help consumers better understand costs and price variability.
To that end, the Department of Insurance (TDI) has partnered with the University of Texas, School of Public Health to revisit this effort, evaluate the progress of health cost transparency to date, and to make improvements to enhance Texans' ability to obtain meaningful and relevant information on health care prices. TDI and various stakeholders will use this partnership to develop recommendations to submit to the legislature for the upcoming legislative session.
Everyone agrees that consumer's health care literacy and awareness of heath care costs (transparency) are important to health care reform. When the State of Texas can identify and understand the variations in payment and quality across plans and providers, and when the right combination of data is used for decision-making we should expect cost containment and quality improvement efforts come to fruition. .
About Texas Association of Health Plans (TAHP)
Texas Association of Health Plans (TAHP) is a statewide trade association representing effectively all health plans (Commercial, Medicaid, CHIP and Medicare) doing business in Texas and is committed to improving access, value and quality of care throughout Texas. Utilizing legislative advocacy, education and collaboration with other member organizations, TAHP brings together industry leadership to develop answers to critical health care issues in the state. For more information, please visit www.tahp.org or call (512) 476-2091.