November 12, 2013
Calls for more transparency in health care pricing are gaining momentum: bombshell magazine articles and government actions that have shed light on the mystery that often surrounds health care prices; controversy about the use and validity of “chargemaster” prices by hospitals; and mounting evidence of variation in the costs for routine procedures. At the same time, some providers have begun to voluntarily reveal their negotiated payment rates with insurers, while some payers are beginning to cap the amount they will pay for certain types of care (but still allowing consumers to choose more expensive options if they absorb the additional cost).
At the conference, speakers discussed transparency reforms nationally and in trailblazing states and described transparency initiatives in New York State. Consumers, providers, insurers, employers, policymakers, and researchers attended the event.
Uwe Reinhardt, Professor of Political Economy at Princeton University, delivered the keynote address. Professor Reinhardt provided an extended metaphor that explained the health care system as a “fortress,” with prices set effectively in secret by a small group of “nobles.” Professor Reinhardt described the ways this system contributes to ever-rising costs and offered a sweeping look at what could be done to improve the system.
The first panel discussed various ways that payment reform is being addressed outside New York. Andréa Caballero, Program Director at Catalyst for Payment Reform (CPR), described CPR’s methodology for evaluating state laws regarding health care price transparency and the resulting national scorecard on state price transparency. She also outlined how New York could improve its F grade on this scorecard. Christopher Koller, President of Milbank Memorial Fund and former Rhode Island Health Insurance Commissioner, discussed common state government efforts to promote price transparency—including price databases for public access, chargemaster analysis, and fee schedule analysis—and lessons learned on the state’s role in making improvements. Dr. Gerard Anderson, Professor and Director of Center for Hospital Finance and Management at Johns Hopkins Bloomberg School of Public Health, provided his perspective on the many components that are needed to make price transparency a reality, including the reasonable rate a hospital should receive for treating a class of patients.
The second panel, moderated by Kathryn Wylde, President and CEO of Partnership for New York City, discussed how payment reform is taking place in New York State. Robin Gelburd, President of FAIR Health, explained how FAIR Health came to create a public database that provides access to health care cost data and described the transparency landscape in New York State. Paul Macielak, President and CEO of New York Health Plan Association, gave examples of price transparency from around New York State and noted that doctors and hospitals are also responsible for disclosing estimated costs. Dennis Whalen, President of the Healthcare Association of New York State (HANYS), spoke about the state of billing practices, as well as the practical, financial, regulatory, and timing-related challenges to price transparency.
This conference provided examples of tangible next steps in addressing price transparency, along with a clear perspective on the barriers to transparency that remain in New York State and across the country. The speakers addressed the broad spectrum of factors that will come into play as consumers, employers, and the government continue to seek price transparency as a key component of payment reform and cost containment.
Download the conference speakers’ PowerPoint presentations below: