February 11, 2020
Proposal offers alternative to federal government’s top-down approach to price information while simplifying the consumer experience
Washington – Today the Alliance of Community Health Plans (ACHP) has proposed a certification framework for digital health care pricing tools that makes quality and pricing information accessible, understandable and actionable for consumers. Outlined in a new issue brief, ACHP offers a core set of standards for meaningful price transparency and lays out a roadmap for independent certification of these tools.
ACHP released the framework in conjunction with a panel discussion on Price Transparency and the Consumer Experience at the 2020 AcademyHealth National Health Policy Conference.
“Consumers deserve useful, personalized cost and quality information to guide their health care decisions. The tools that exist today vary greatly in terms of both content and ease of use,” said Ceci Connolly, President and CEO of ACHP. “Current price transparency proposals burden consumers with a dump of raw data instead of helping them navigate an already complex health system. Customized information that reflect a patient’s individual coverage benefits in real-time is critical to making health care options more predictable and visible to consumers.”
Individuals and families are increasingly spending more of their own money on care without the most basic cost and quality information. As overall health care costs grow at an unsustainable rate, health plans are poised to lead price transparency efforts by helping consumers select services and clinicians based on cost and quality considerations.
ACHP developed a framework to evaluate which digital pricing tools would be most useful to consumers. The ACHP framework allows for customization based on consumer needs. At a minimum, price transparency tools should include the following:
- Search and find capabilities
- Cost estimates for a variety of items and services
- Personalized guidance based on an individual’s actual medical benefits, history and costs
- Location, distance and convenience of care options
- Meaningful patient engagement to foster participation
- Specialized assistance for complex cases
- Consumer input
Under the framework, ACHP recommends an unbiased, independent body bestow a seal of approval, or “certification,” on consumer pricing tools that meet or exceed a baseline of transparency principles. Certification would verify that the health plan’s publicly available information is accurate, timely and relevant to patients and families as they make critical, intensely personal health care decisions. With access to such independently certified sources of price and quality information, consumers would find shopping for medical services as comfortable as other retail experiences.
“To fully empower patients, any transparency tool must include quality information alongside prices. As with other purchases, only when consumers have a complete, accurate picture of the service will they be able to best evaluate options and make the decision that fits their individual needs,” said Connolly.
ACHP member organizations are early innovators in making quality and pricing information available and useful for consumers. At the 2020 AcademyHealth National Health Policy Conference today, Connolly moderated a panel with representatives from three ACHP member companies – HealthPartners, Presbyterian Healthcare Services and Priority Health – that have successfully implemented useful, personalized price transparency tools, which ACHP used as models for the proposed framework.
“We believe independent certification ensures that patients and families have easy access to the information they need — when and how they want it. We invite other transparency proponents to join us in creating a trusted resource for American consumers,” said Connolly.
Ceci Connolly as well as leaders from HealthPartners, Presbyterian Healthcare Services and Priority Health are available for media interviews and able to discuss the digital price tools offered by their respective plans. Please contact Dan Lemle for more information.
The Alliance of Community Health Plans (ACHP) represents the nation’s top-performing non-profit health plans to improve affordability and outcomes in the health care system. ACHP member companies are provider-aligned health organizations that provide high-quality coverage and care to tens of millions of Americans. They are leading the industry in practical, proven reforms around primary care delivery, value-based payment and data-driven systems improvement.
ACHP advocates on behalf of its members and a unique approach to health care today, one that puts the patient at the center with health plans and clinical teams collaborating to improve health outcomes and reduce costs. Our advocacy focuses on providing policymakers with tested solutions being realized in communities nationwide and rooted in a model that is proven to deliver better value for patients, employers and taxpayers. Learn more at the ACHP website and follow us on Twitter for the latest health insights.
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