Statewide initiatives raise the bar on health care transparency.
When your car breaks down, the fix is easy: you check Yelp ratings, request a few estimates, and pick the mechanic offering the best service for the best price. The faulty part gets replaced, and then you pay your bill and drive off into the sunset.
But when a body breaks down, notes Oregon Association of Hospitals and Health Systems President and CEO Andy Davidson, the solutions aren’t so straightforward. How do you shop for a hip replacement if you have a complication like diabetes? What defines a good health care value? And what happens if things don’t go as planned?
“Having a complex procedure in a hospital is not like having a water pump replaced in your car,” says Davidson. “Human beings are dynamic entities. The unexpected happens.”
And the unexpected can take many forms. Though 95 percent of Oregonians are now insured, high deductibles, out-ofnetwork care and unforeseen expenses are inescapable features of the post-Affordable Care Act landscape.
It’s a confusing time to be a health care consumer, says Greg Van Pelt, President of the Oregon Health Leadership Council, and price uncertainty often drives that confusion.
“You can’t pick up a newspaper and read a story regarding health care or legislative issues without running into this issue of out-of-pocket costs,” he says. “Plans have gone to high deductibles, tighter provider networks. Price transparency is a great issue.”
Inspired in part by calls from Oregon’s business community, two smart online tools developed by OAHHS and OHLC are reducing that guesswork — and transforming the way Oregonians and their employers shop for health care services.
OregonHospitalGuide.org allows insured and uninsured consumers to compare costs for the 50 most common inpatient and the 100 most common outpatient procedures at various hospitals, view quality information and contact hospitals for details on financial assistance policies.
And WhatsMyCost.org helps insured consumers easily contact specific insurance plans to request out-of-pocket cost estimates for common in-network procedures.
Such tools make good on the promise of 2015’s Senate Bill 900, which publicizes price data for common hospital procedures in Oregon. The bill was requested by both OAHHS and OHLC, and it’s already bearing fruit: in a national report card published earlier this year that evaluates state price transparency laws, these initiatives helped Oregon earn a “B” grade for health care transparency — making it one of just seven states in the nation to earn above an “F.”
Self-insured and insurance-purchasing businesses can’t always shield employees from health care unknowns, but these online tools help them to break down health care prices, and, in turn, assist workers to navigate this sometimes-perplexing terrain.
There’s much left to learn, says Davidson, but Oregon is off to a strong start: “This creates a sense of trust between a patient and their hospital. It is an online tool that has enabled patients to make informed choices.”
Of course, Davidson warns, patients should never shop for health care based on price alone, and that’s why OregonHospitalGuide also provides quality of care scores for each hospital in the state.
What will it take to bump Oregon’s health care grade to an “A”? Even better alignment between estimates and final prices would help, says Van Pelt, plus continued buy-in from Oregon’s individual health plans and providers, many of which are already developing their own price-estimation tools.
The project of improving transparency within our health care system is just beginning, he promises: “We’re trying to build the feedback loop right now. This is really complex, and what we want to do is demonstrate our commitment to work together to make this experience better for consumers.”