Eliminating the Mystery of Healthcare Costs & Quality

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October 19th, 2012
Categories: Health News

Healthcare MysteryWith rising healthcare costs and the increased availability of cost and quality data, it is hard to ignore the push towards transparency and consumerism in the US healthcare industry.

In our current healthcare system, providers and healthcare organizations set inflated prices for their services that are rarely paid by large payers. Uninsured patients who lack the expertise to negotiate their medical bills are often burdened with this inflated price. The pricing of healthcare services in this way is often the result of cost shifting funder-funded care provided under Medicare/Medicaid.  It also serves as a counter-balance the leverage that large health plans have in negotiating their rates. This inflated pricing of services means that patients typically have no idea how much their care will cost or how much they will be required to pay. Paying for healthcare can often be seen like signing a blank check; the patient has no idea what the price is, but the service is needed. Combine this with a lack of information on the quality of care that a provider delivers and it is impossible for patients to assess the true value of the healthcare services they are receiving.

Recently, steps have been taken to implement transparency in the healthcare system.  The Federal government mandates public reporting through the Patient Protection and Affordability Care Act (PPACA), and more than 30 states are in the process of, or are considering legislation to increase price transparency. For example, New Hampshire and South Dakota support websites that report comparative information on healthcare costs. California requires hospitals to provide uninsured patients with price estimates and cannot bill for amounts higher than government reimbursement amounts. Massachusetts passed the Act to Promote Cost Containment, Transparency and Efficiency in the Delivery of Quality Health Care in 2008. And lastly, Wisconsin’s health care law, stating patients have the right to information of costs took effect in January 2011.

There are various online tools to help patients choose the right providers before using their services. The resources below can help determine value of provider's health services by comparing quality and cost.

Healthcare Quality

Healthcare Cost

 

PayerFusion is a Health Plan Administrator and Cost Containment company offering comprehensive solutions for self-funded employers and international payers.  Our health plan administration solutions are customized to meet the needs of our clients and include provider network design/support, policy design, full-service TPA, technology solutions/support and informatics.  Contact us for more information and to learn more about our health plan administration services