Tools for Price Transparency


In Part One, “Patients Ratchet Up Demand for Price Transparency,” we examined the current state of price transparency and the short and long-term impacts failing to address patient demands for accurate estimates may have on U.S. hospitals. In Part Two, we look at tools and resources available to help hospitals streamline transparency initiatives.

The stakes are high for the more than two-thirds of U.S. hospitals that are not yet offering price estimates to help patients better manage their share of healthcare costs. Patients, who now make up the second largest payer group behind only the Centers for Medicare and Medicaid Services, have made it clear that they expect greater pricing transparency. According to a Public Agenda survey, 56 percent of respondents said they actively look for pricing information before getting care, including 21 percent whose final choice was impacted by comparison shopping across multiple providers.

There is also the direct hit to the bottom line. Research indicates that 80% of patients who receive accurate costs estimates will pay their bills in a timely manner—a significant amount considering patient payment liability was expected to hit to $420 billion in 2015.

HFMA Guidance

The good news is that there are more resources than ever to help hospitals maximize the effectiveness of price transparency initiatives, including the HFMA’s “Improving Price Transparency.” This web-based resource offers everything from a guide to help consumers better understand and manage their healthcare costs to reports from the organization’s Price Transparency Task Force to best-practice guides to guiding principles.

At the heart of the HFMA program are the what the organization has identified as the four essential elements of any price transparency tool for insured patients:

  1. Total estimated price of the service: The amount for which the patient is responsible plus the amount that will be paid by the health plan or, for self-funded plans, the employer.
  2. Network status: Whether a particular provider is in network and information on where the patient can try to locate an in-network provider.
  3. Out-of-pocket responsibility: A clear statement of the patient’s estimated resulting out-of-pocket payment responsibility, tied to the specifics of the patient’s health plan benefit design, including coinsurance and as close as possible to the amount of deductible remaining to be met.
  4. Other relevant information: Information related to the provider or the specific service sought, such as clinical outcomes, patient safety or satisfaction scores, when available and applicable.

For example, Maine HealthCost is one of only two state-mandated transparency websites nationwide and is maintained by the Maine Health Data Organization, an independent executive agency established by the Maine legislature in 1996. It provides data on actual paid amounts for a variety of procedures and services, enables comparisons of average prices for procedures at different facilities in the state and provides links to cost calculators that health plans offer for their subscribers in Maine.

The Wisconsin PricePoint system, maintained by a subsidiary of the Wisconsin Hospital Association, enables patients to do web-based searches by facility for inpatient, outpatient surgery, emergency and urgent care, and other hospital outpatient services. Though information varies by category, it typically provides average and median charges, a comparison of charges between providers at the county and state levels, and information on the provider’s volume for the selected service. Patients can also run comparisons between providers.

Access is not Enough

While a step in the right direction, the unfortunate reality is that the pricing information currently available from hospitals and other healthcare organizations is insufficient to meet patient needs. Today’s patient is managing increasingly complex benefits plans that typically bring together high deductibles, high out-of-pocket fees, and special carve-outs and coverages for different procedures. This calls for pricing information that is easily accessible, tailored to a patient’s circumstances, understandable and actionable to move the patient satisfaction and payment needle.

One approach is to combine personalized cost estimates with simplified payment options, such as SwervePay Cost Estimator.

SwervePay Cost Estimator makes it easy for patients to understand out-of-pocket costs before and at the time of care and removes the biggest bottleneck to a reliable cost estimate – accurate benefits data. It uses a combination of technology, services and direct partnerships with insurance companies to access relevant and accurate eligibility data from every health plan. The analytics engine blends that data with providers’ negotiated contracts and claims history to create an accurate, personalized cost estimate for each patient.

SwervePay’s payment tool facilitates better communication with patients around cost of care, helping them to better understand payment options and conveniently pay their bills. It offers an innovative suite of tools for making patient payments, without apps or paper. Just one-click payments via text message. The company’s platform also alleviates manual tasks in the revenue cycle process for providers, health systems and payers.

Together, SwervePay Cost Estimator educates patients about their insurance plans and offer convenient payment choices, capabilities that are an integral part of a positive patient experience. They enable price transparency, address growing demand for accurate estimates and enable hospitals and healthcare organizations to maximize payment collections and, subsequently, patient satisfaction.

To learn more about the innovative price transparency and patient payment tools available from SwervePay Health, visit booth #2040 at the HFMA National Institute, taking place in Las Vegas June 26-29.