The Empire Strikes Back

Submitted by francois.debrantes@hci3.org on Friday, August 1, 2014 - 02:44

The Empire Strikes Back – Last week, UnitedHealthcare announced that it would make its price transparency tool available to everyone in the country, irrespective of whether they are a UHC member. Health4Me, which is the name of the app, provides consumers with price comparisons, by provider, by episode, and is very useful. While the release seems innocuous and even benign, it is anything but that. Since Castlight's inception, United has been one of the few plans that has steadfastly refused to provide the start-up with claims data, arguing that whatever information would be generated by the newcomer could be misleading and out of date. It had a point. But without a reasonable alternative, it sounded as if the health care insurance giant was simply trying to resist the noble rebel forces that were striving to bring some light to the darker corners of the health care universe. With the release of this app to the general public, United has fired off the death star ray towards downtown San Francisco. What happens next is anyone's guess, but there's little doubt that we have entered into a new chapter of the movement towards full and complete pricing transparency, and none too soon.

What this means to you – While consumer-friendly price information is still hitting its growing pains, it's at least on a path towards the ultimate fulfillment of its goals. Providers, however, are still lagging in both their acceptance of the concept of pricing transparency (let alone its execution), and the means to make it useful. A recent article in Managed Care underscores how difficult it is for physicians to think of themselves as the stewards of their patients' physical AND financial health, and yet both are intricately linked. How can a patient be compliant if he can't afford the medication prescribed? How can a consumer be active in her decision-making if she's not told how much each treatment option will cost? Some states, like Maine, have adopted laws that compel hospitals, physician practices and other providers to list the list price of the most common procedures they undertake in any year. Combined with APCD data that shows the discounted/negotiated price, consumers should be armed with the information they deserve to make rational choices. They can start asking questions about the difference between the list price and the negotiated ones and avoid the significant financial hardship that comes with buying care with a blindfold. The rebels have shown that they can make enough of an impact to get the Empire's attention, even if it does hurt when the death star fires off a shot. But as we all know, that's not the end of the story. The fight for complete price transparency is far from over.

Sincerely,

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