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Expert: price transparency needed to rein in health-care cost variation
Summary
Suzanne Del Blanco of Catalyst for Payment Reform told the board that price and quality transparency are essential for purchasers and consumers, detailed federal and state rules in play (CMS hospital charge rule, Transparency and Coverage Rule, California’s Healthcare Payments Data Program) and urged purchasers to press plans for compliance and data sharing.
Suzanne Del Blanco, executive director of Catalyst for Payment Reform, presented a board education session on price and quality transparency in health care and how purchasers such as SFHSS can use those tools to improve value.
Del Blanco said purchasers need access to meaningful price information because "prices are one of the biggest drivers in health care cost growth" and because wide price variation exists among providers regardless of quality. She reviewed gaps in consumer-facing plan tools, vendor workarounds, the advantages of all-payer claims databases and recent federal and state actions — including the CMS hospital price-transparency rule, the federal Transparency and Coverage Rule requiring machine-readable negotiated rates, and California’s Healthcare Payments Data Program (the state all-payer claims database effort).
Del Blanco noted implementation challenges: incomplete plan/provider compliance with rules, low consumer uptake of price tools, and health-plan reluctance to share proprietary data. She recommended purchasers hold plans accountable, request compliance plans and support development of episode-based price definitions (bundles) to simplify comparisons.
Ending: Commissioners thanked Del Blanco for the briefing; staff discussed next steps including asking health plans for their compliance workplans and monitoring federal and state rule implementation and enforcement.
