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Answering Consumer Questions on Health Care Costs

Also posted on Project Health Colorado blog

Last month, Project Health Colorado, an initiative of The Colorado Trust, asked me to address a common theme raised in posts on their website about the lack of cost information given to patients before receiving health care services. John from Colorado Springs wrote, "It's completely unacceptable that we're letting our healthcare providers get away with NOT providing us with good faith estimates of what our portion of the charges will be!" And a post by Taneil from Boulder summed it up best. "For each procedure there should be sane ways to assess benefits and costs. People are totally uninformed in both areas."

So what changes need to be made so that consumers understand the cost of their health care before they buy it?

It’s nearly impossible to make a smart shopping decision without access to good information about cost and quality. Virtually every industry besides health care provides easily available information on price, consumer satisfaction and other quality metrics. In health care, however, we put consumers in a difficult situation. Consumers are told to be more cost conscientious, yet they don’t have any information to act upon. To put patient in the driver’s seat, we must provide up-front cost transparency with quality and outcomes information.

Why aren’t prices and outcomes for health care services provided to patients ahead of time or simply posted on the wall of your physician office? Besides the fact that it’s not required and most patients aren’t demanding up-front costs, there are many reasons prices aren’t readily available to patients. Here are the top three:

  1. Funding of health care is a broken and complex system. Multiple insurers have numerous plan variations and pay different rates to providers. To make it worse, generally all parties are contractually forbidden to disclose their rates. Nothing is designed to make it easy for the patient.
  2. Costs are often broken into two parts: physicians’ fees and facility fees -many times operated by different organizations. In those cases, neither organization has the other’s cost information. So, getting a complete picture of the costs a patient will pay is nearly impossible.
  3. Patient complexities, or how sick a person is, can impact cost, making it difficult from the provider or facility level to provide accurate estimates.

Fortunately, Colorado is moving towards full transparency and making sense of the complex health care cost maze with the Colorado All Payer Claims Database (APCD). By the end of the year, the website www.cohealthdata.org will provide cost and quality information by named facility and provider group enabling consumers to make informed decisions about their health care. The website currently shows high level cost and utilization information for Medicaid and the largest commercial health plans. Check out the New Hampshire APCD site for an example of the consumer information that will be available for Colorado late this year.

CIVHC, as administrator of the APCD, is in the midst of determining how best to display and report price and outcomes information so it is user friendly and easy for patients to understand. If you’re interested in providing input for this important patient resource, please contact us at info@civhc.org.

About the Author: Phil Kalin is CIVHC's President and CEO. Contact him at pkalin@civhc.org.

About Project Health Colorado: Project Health Colorado is an initiative of The Colorado Trust that gives Coloradans a forum for making their voices heard about health care. Through the website and Project Health Colorado Facebook page, Coloradans can say how they want health care to work for them. Project Health Colorado then shares these ideas with Colorado's leaders. Many Coloradans asked questions and made suggestions about better transparency in health care costs. This blog post in response to those concerns is featured on their website.

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