Until recently, consumers needed a
crystal ball to predict the cost of certain medical services. Charges for procedures like strep tests and X-rays were
a great mystery — until the bill arrived. But
why should consumers remain in the dark
about something as important as the cost
of their health care?
Having the right information is essential
when purchasing health care. Consumers
should have access to the same kind of
objective cost and clinical quality information that is readily available when making
any kind of significant purchase, such as
buying a car, house or computer.
“Consumers are taking on an increasingly active role in the overall health care
process,” said Bill Berenson, senior vice
president of Aetna’s Small and Middle
Market Business for the North Central
Region. “This presents an opportunity for
employers, regulators and the medical
community to work in collaboration
toward a more transparent system.”
Smart Business spoke with Berenson
about transparency in health care and the
emerging technologies that are shedding a
new light on cost and quality.
What is transparency?
Health care transparency is a variety of initiatives that help people make informed
health care decisions based on a number of
factors, including the actual costs of care
and the clinical quality and efficiency of
physicians. This kind of information was
not previously available to consumers, but
insurers now have a responsibility to give
them the information they need to make
well-informed decisions about their health
care. Transparency is gaining momentum as
a driving force in the health industry.
Do employees benefit from price information?
Employees can benefit in many ways, as they can now learn the cost of certain medical procedures upfront. An individual
planning to see a new doctor can review
charges for an office visit. Parents whose
child is suffering from a sore throat can
find out what they can expect to pay the
pediatrician for a strep test. A family
preparing for flu season could learn what it
can expect to pay the doctor for a flu shot.
Knowing actual rates can help your
employees manage their annual out-of-pocket expenses and make better decisions about how to use their benefit plans.
What kind of technology is available to help
consumers gather price information?
Online tools can give consumers easy
access to actual rates negotiated with doctors for the most frequently performed
treatments and services. Personal Health
Records (PHRs) provide online access to
personal health information, including
drug prescriptions, medical tests, individualized personal messages, alerts and a
detailed health history that can be printed
and shared with physicians. Still other tools can provide information about hospitals according to specific diagnoses and
procedures, such as the number of patients
treated per year, complication rates, mortality rates and length of stay. This information can help consumers decide where
to access care. Integrating information and
resources helps patients and their physicians make more informed decisions and
better manage their health and health-related expenses.
How does transparency impact employers?
Transparency may have its biggest
impact on employers as they shift toward
consumer-directed plans. Giving people
credible, easy-to-understand information is
an essential part of the consumer-directed
movement. Transparency not only provides this kind of information; it also
demonstrates the insurer’s commitment to
both the employer and its employees.
What’s next?
Price transparency is only the beginning.
Patients need enough information to make
decisions based on overall value, not simply price alone. Transparency efforts are
expanding to provide consumers with
information on quality as well as cost efficiency. The health-related choices we
make for our families and ourselves are too
important to make in the dark.
BILL BERENSON is senior vice president of Aetna’s Small and
Middle Market Business for the North Central Region. Reach him
at (312) 928-3323 or [email protected].