Catalyst for Payment Reform (CPR) has issued a declaration to health plans and providers, calling on them to make health care price information transparent to employees and consumers.
CPR, an independent organization led by large employers and other health care purchasers, including 3M, Boeing, and Disney, has been working to reform health care pricing, and has produced tools to help consumers compare rates between providers. CPR's statement has the support of AARP, the AFL-CIO, the Corporate Health Care Coalition, The Leapfrog Group, the National Business Coalition on Health, the National Partnership for Women and Families, the Pacific Business Group on Health, and several others.
According to this article in Radiology Business Journal, medical imaging is especially vulnerable to price disparity where costs for MRI exams can vary from $300 to $3,000. This is due to leverage where hospitals with better brand recognition command better rates. In addition, Medicare payments to imaging centers are being lowered in favor of higher hospital rates. Transparent price information can help consumers drive down prices and increase competition in the market for imaging exams.
While there are efforts by health plans and independent vendors to make price information available to health care consumers, they have been stymied by lack of available pricing data. Existing tools are not comprehensive or user-friendly enough. Some health care providers restrict access to price data by prohibiting health plans from making their negotiated payment rates available.
Adding to purchaser frustration, some health plans restrict how self-insured employers can use their own claims data, according to the press release. These restrictions can prohibit employers from giving their own claims data to third-party vendors who may have alternative price transparency tools or ways of interpreting the data.
Despite these obstacles, CPR has developed specifications employers and consumer groups can use to assess currently available tools. In conjunction with its call to action, CPR has contacted major national health plans, encouraging them to share data. CPR has also released an Action Brief on price transparency, summarizing the issues and listing steps purchasers can take to promote transparency, including advocating for effective state-based all-payer claims databases, and using CPR's health plan sourcing and contracting tools to remove limits on data usage in contracts with plans, according to the release.