September 19, 2018

Health care price tool could be 'game changer'

A new state website designed for patients to compare health care provider prices launched earlier this year, but the head of the agency behind the tool said he thinks one of the site's features that goes beyond cost comparisons and quality metrics could ultimately make the most difference for patients.

Ray Campbell, executive director of the Center for Health Information Analysis, said at an oversight hearing that he sees consumer education as a "major emphasis" of MassCompareCare.gov.

Campbell said if someone is about to have an MRI, they may be interested in knowing what their doctor would get paid for it, but they would also benefit from knowing where MRIs are performed and what they should ask their doctor and insurer beforehand.

"Just as Google got quite wealthy by realizing that when somebody's searching for the word 'toaster,' that's a very good time to put a toaster ad nearby, if you've got somebody that's searching for the price of an MRI, that's probably a really good time to present information to them about here's questions to ask your doctor if you're getting ready to have an MRI," Campbell told the Health Care Financing Committee.

Launched in May, the website uses claims data to show the full amount medical providers were paid by both the insurer and the patient for nearly 300 procedures including X-rays, MRIs, office visits and blood tests.

Campbell said CHIA is thinking about ways to improve the site in future iterations.

The agency released all the data behind its procedure pricing tool last month, putting out information Campbell said could be used to analyze policy and provide a "picture of price variation in Massachusetts."

The issue of price variation -- a dynamic in which medical providers are paid different amounts for performing the same procedure -- has long vexed policymakers in Massachusetts. A special commission released recommendations to address price variation in 2017, and some of those ideas were worked into health care legislation that collapsed when lawmakers could not reach a deal by the July 31 end of formal sessions.

Rep. Jeffrey Roy, the committee's vice chair, told Campbell it seemed like the new site and its data could be a "game changer" in the health insurance industry, and said the information is significant given the role patients play in paying for care.

Roy, a Franklin Democrat, cited statistics from an annual health care analysis CHIA released last week showing that member cost-sharing grew 5.7 percent --faster than inflation and wage growth -- in 2017, and that 28.2 percent of residents with private commercial insurance were enrolled in high-deductible health plans.

"Depending on your point of view, this ongoing move towards consumerism may mean that more patients have a greater say in how they spend their health care dollars, or that more costs are being shifted onto patients as a means of cutting spending or something in between," Roy said. "Regardless of where one falls, what is apparent to all is that the trend shows no sign of reversal, which means that if patients are being asked to act like consumers, they need access to transparent information on price, quality and availability of services so they can make informed choices."

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