Three Key Lessons from the Health Care Transparency Summit

Apr 16, 2015, 1:36 PM, Posted by Anne Weiss, Susan Dentzer

“There is no single more powerful concept” in transforming health care than transparency—that is, accurate information for everybody about the costs, quality, and other aspects of health care—according to former US Senate Majority Leader and Robert Wood Johnson Foundation Board Member Bill Frist at the Second National Summit on Transparency in Health Care Costs, Prices, and Quality. Not only is shining the spotlight on costs and quality the key to making health care markets work, Frist said, but it’s also central to delivering the vaunted Triple Aim of better health, better health care, and lower costs. Here are our key takeaways reflecting how much transparency discussions have advanced since the first RWJF sponsored summit in 2013:

1. Transparency may not be ubiquitous, but it’s now a permanent feature of the health care landscape.

Niall Brennan, chief data officer of the Centers for Medicare and Medicaid Services, told conference attendees that a multi-day conference on the topic would have seemed implausible just five years ago, since “there was so little happening in terms of health care transparency.” But now a variety of purchasers are demanding more transparency around health costs and quality, not just to get the best value in health care but also to drive change in the delivery system.  Strapped consumers facing high health insurance deductibles and other cost-sharing are increasingly comparing health care charges and prices as well. According to an RWJF-sponsored survey by the Public Agenda Foundation, 56% of Americans have actively looked for such information before getting care.

The federal Open Data Initiative, along with CMS websites, such as Nursing Home Compare, have put an unprecedented amount of price and quality information in the hands of consumers.  Meanwhile, major health insurers, and a host of companies such as Castlight Health, have introduced new transparency tools. One new entry is the Health Care Cost Institute’s guroo.com, a web site that provides national, state, and local cost information for such common health conditions and services as hip and knee replacement surgery.

As a result, transparency and open data are emerging as a “a force multiplier for delivery system reform,” observed Tim Gronniger, senior adviser for health care policy at the White House Domestic Policy Council. Information about costs and quality are now at the heart of new payment models such as accountable care organizations. Meanwhile, a number of state hospital organizations, including Indiana’s, are publishing data online about their members’ hospital charges, while the American Hospital Association has a toolkit that encourages hospitals to have staff who are specifically trained to discuss prices with patients and their families.

And RWJF itself has abetted the cause of transparency in costs and quality, and in consumer engagement in health care, through its support of programs such as Choosing Wisely and Open Notes.

2. For all the progress made in transparency, there’s much more work to be done.

Despite the progress, the summit featured numerous examples of ways in which transparency could be improved. A report by Catalyst for Payment Reform and the Health Care Incentives Improvement Institute shows that only a handful of states are aggressively spurring transparency through such approaches as all-payer claims data bases. Meanwhile, much useful data available about health care has gone unexplored; Brennan pointed to seven years’ worth of county-level data in fee-for-service Medicare that could help communities better understand where their health care dollars are going, but that are woefully underutilized.

3. There’s a paradox: The more transparency we have in health care, the more we expose how little we actually know or understand.

Concern about keeping health costs affordable has led to the emergence of narrow networks, which in turn has given rise to another problem: When patients seek care at a hospital that is in their health plan’s network, but then receive care from non-network providers, such as anesthesiologists—and incur sharply higher cost-sharing as a result. Hospitals don’t always know which of their providers are in-network for different consumers, and health plans don’t always have that information readily available, either. New York State recently attacked some aspects of the problem by enacting legislation mandating more transparency by health plans about out-of-network charges and protecting consumers against “surprise” bills from out-of-network providers.

The bottom line: Transparency is helpful, but it isn’t going to solve many major problems in a huge, often dysfunctional health care and financing system. As Sally Welborn, senior vice president of global benefits for Wal-Mart Stores said, “The apple is really big. How are we going to start taking bites at it?”

Anne Weiss

Anne F. Weiss, a director for the Robert Wood Johnson Foundation, leads efforts to achieve the highest possible value from our nation’s investments in improving health and health care. Read her full bio.