We are happy to announce the fourth installment of the Health Care Incentives Improvement Institute (HCI3) – Catalyst for Payment Reform (CPR) Report Card on State Price Transparency Laws.The health care leaders who have been following our report card since it was first released in 2013 will not be surprised by some of the states earning the highest grades in this 2016 edition. Colorado, Maine, New Hampshire,Vermont, and Virginia again stand atop the rankings, with Colorado and Maine moving from Bs in 2015 to As this year. Joining the leading states for the first time is Oregon, whose new transparency law and consumer-facing transparency website earned the state a B this year after receiving an F last year.
The quality of their transparency websites drove up Colorado’s and Maine’s grades (and contributed to Oregon’s new grade), underscoring that how states present price information—in addition to how they collect it—is essential for making price information accessible and usable for consumers. As such, this year’s report card contains a special feature focusing on the best practices for displaying price information as identified by Dr. Judith Hibbard, of the University of Oregon, an expert in how consumers and patients experience, absorb, and act on information about their health care.
In addition, this year’s report card offers low-performing states specific recommendations for how they can improve their grade. As in previous years, our scoring methodology rewards states with all-payer claims databases (APCDs) and that publish those data on a well-designed, state-mandated website. That level of commitment remains the model for truly robust price transparency laws. However, our recommended improvements (reflected in Table C) tackle incremental change as well, encouraging states that already collect data to make it more accessible to consumers. Furthermore, not every F is created equal. For instance Louisiana and Washington have new APCD legislation that calls for publishing price information online, but have not yet launched those websites. If such websites are well designed and online by next year, these states can expect to see their grades rise markedly.
Another new aspect of this 2016 report card is the acknowledgement of not just adopted price transparency laws, but also proposed transparency legislation. We recognized a trend in proposed legislation focusing on directing providers or insurers to disclose prices to patients prior to a procedure or service. While this approach is rooted in common sense, it is not a substitute for state laws that require the collection and publication of a wide range of price information. Moreover, although the private sector has made great strides in enhancing price transparency, access to price information often is dependent on the employer or insurer a consumer has and, of course, some have neither. Therefore, there is still an important role for states to play in ensuring that their citizens have access to the information they need to make informed health care choices.
The 2016 Report Card on State Price Transparency Laws is a product of collaboration among valued partners. Analysts at The Source on Healthcare Price and Competition—a program of the University of California, Hastings College of the Law and the University of California, San Francisco—conducted legislative research and summarized each state’s enacted and proposed legislation on health care price transparency. Dr. Hibbard provided her valuable insights on how to make price and quality information accessible and actionable to consumers, one of the several ways the report offers a path forward for states willing to improve transparency.
These combined contributions make this document a roadmap for improved transparency at the state level, in addition to a report card with grades. Now, it’s up to states to act. When they do, we will recognize their improvements in subsequent report cards.
François de Brantes
Special thanks to Elizabeth Cronen and Elizabeth Bailey, HCI3; Lea Tessitore, Andréa Caballero, and Spencer Sherman, CPR; and Anne Marie Helm and Becky Wildman-Tobriner of The Source on Healthcare Price and Competition for their contributions to researching, writing, and editing this project.