There's a big problem with our healthcare system today: Consumers don't know prices for health services or procedures, so they can't make informed decisions about where and whether they receive care.
As it turns out, there are many ways for consumers to get pricing information. So if these tools exist, why don't consumers use them? Therein lies the real healthcare problem.
Although 95 percent of plans make various types of transparency tools available for their members, just 2 percent of members use them. "I would say consumers absolutely have more power than they take advantage of today," Doug Ghertner, chief executive of Change Healthcare, told MarketWatch.
Mitch Rothschild, chief executive of Vitals, which offers doctor reviews, believes consumers don't use available tools because they don't actually consider themselves to be consumers when they get healthcare. They're simply not used to that idea, he said.
That's partly because insurers have long been the gatekeepers of health prices, negotiating deals with individual providers but not sharing that information with their members. Along the way, consumers just got used to not knowing--and not even thinking about--the cost of their healthcare.
Some industry experts think the tide may be turning. "We are very much at a place now where people are increasingly demanding, where people are increasingly expecting, and where people are increasingly supported in being much more in power to have greater control over their healthcare," said Reed Tuckson, a former UnitedHealth Group exec and now an industry consultant.
That awareness happens most frequently when consumers are enrolled in plans with high cost-sharing features such as high deductibles, coinsurance and copays. Having to pay more out-of-pocket costs usually means consumers are more aware of and concerned with prices.
These cost-sharing plans will start driving consumers to closely examine costs and even push back against providers for their charges, especially once they see that "there's almost no correlation between price and quality," says Suzanne Delbanco, executive director of the Catalyst for Payment Reform.
In fact, a Cigna study showed that consumers enrolled in plans with high cost-sharing shift their health-related behaviors, which leads to lower costs.
If and when consumers become better stewards of their own healthcare costs, Change Healthcare's Ghertner estimates that as much as $184 billion could be saved. With that much money on the line, I hope insurers beef up their marketing and outreach efforts to educate their members about any existing price transparency tools. I also hope that insurers continue to develop these tools and share cost information to help make members more cost-savvy.
Then we'll start to see the needle move faster toward greater healthcare savings. - Dina (@HealthPayer)