Empowering Health Care Consumers

Grantee Name

HonestHealth

Funding Area

Empowering Health Care Consumers

Publication Date

August 2019

Grant Amount

$228,388

Grant Date:

July 2017 – April 2018

Consumers are eager for health care quality and price transparency tools to inform decision-making and allow for comparison shopping.

An NYSHealth-funded survey by Public Agenda found that nearly half of New Yorkers have attempted to look up health care costs, but there is limited consumer awareness of websites that offer price or quality information. Additionally, the survey found that 80% of New Yorkers believe that the State should provide a way for consumers to compare health care prices. Despite consumer interest and some State efforts in this area, comparative health care quality and cost information has remained largely obscured to the public.

In 2017, NYSHealth awarded HonestHealth a grant to conduct an inventory of existing New York State and national online consumer-focused health care cost and quality resources and tools—assessing their assets and deficiencies—and develop recommendations for New York State to consider when creating and maintaining transparency tools.

Outcomes and Lessons Learned

The report offered guidelines and best practices for the future development of transparency tools for New York residents, including:

  • Ease of Use: Tools should adhere to best practices for consumer-focused user interface designs.
  • Specificity of Information: Where possible, cost estimates should be specific to an individual’s situation and based on that person’s benefits, including insurance carrier and plan, as well as in-network and out-of-network information to determine co-payments and co-insurance for out-of-pocket estimates.
  • Specific Physicians: Many websites reviewed for this project only offered information at the hospital or regional levels. Consumers look for information about individual physicians (in addition to hospitals), including cost, quality, credentials, demographics, expertise, and hospital affiliations.
  • Specific Costs: Pricing data should be based on a dollar amount that represents the total amount paid for a service by both consumers and insurers, as well as the expected out-of-pocket amounts.
  • Relevant Quality: Information regarding quality should be based on methodologically sound measures that consumers care about, such as the effectiveness and safety of medical providers for specific procedures. Tools can rely on nationally accepted quality measures that can be used by consumers to compare provider performance side-by-side. This information should be presented on overall clinical performance and specific areas of care, such as diabetes and cardiac care.
  • Value Assessment: By presenting cost and quality information side-by-side, consumers can make better informed decisions, rather than on relying on misconceptions like high prices indicate high-quality care.

In its inventory of online transparency tools, HonestHealth found a tremendous difference in the information available on these sites and wide variation in what is available. Some sites included data for specific services such as diabetes care or total joint replacements. Some sites included pricing data only at the regional or three-digit ZIP code level, whereas others provided pricing estimates at the individual provider level. And some sites provided estimates specific to an insurance plan, whereas many did not.

During the course of the project, HonestHealth brought in Human Services Research Institute (HSRI) to help analyze the inventory findings, and both organizations collaborated to gather additional clarification and insight into the data and prepare the final report. To help disseminate the findings, Honest Health, HSRI, and the Community Service Society of New York participated in a national webinar, hosted by Altarum Healthcare Value Hub, to discuss how this information can be used to promote best practices in transparency tools.

HonestHealth also presented its findings to various New York State agencies that have the ability to direct the development of future transparency tools for consumers, including the State’s all-payer database (APD). The State is currently undertaking a number of initiatives to advance this goal, including working with HonestHealth to develop a prototype that leverages the data within the APD, Provider Network Database System (PNDS), and New York State Health Profiles to make meaningful price, quality, and network information available to health care consumers in New York. In 2019, NYSHealth awarded Health Research, Inc., a grant in support of this effort to create a consumer-friendly interface. Health Research, Inc., is subcontracting with HonestHealth to develop Nexus, a tool that pulls information from these New York State data sources to provide consumers with the relevant information they need to make more informed health care decisions.

Co-Funding and Additional Funds Leveraged: N/A