Price Transparency to Become the Standard in American Healthcare

Price Transparency to Become the Standard in American Healthcare

Price Transparency to Become the Standard in American Healthcare 1004 591 Apostrophe Health

With Apostrophe’s smart shopper, our members already enjoy the cost-saving benefits of price transparency without waiting on a new federal law.

Everything we do at Apostrophe is guided by simplicity, transparency, and love. We place the highest value on transparency, believing that every patient should know what they’re spending and what they’re saving.

That’s why we’re encouraged to see price transparency requirements issued by the Trump administration. Healthcare in America needs to be fixed, and this is a place to start that benefits every single patient. This historic effort aims to increase competition and lower costs for all Americans. 

The Health and Human Services Secretary Alex Azar says our current system deserves an F, but that after this takes effect, the president has promised an A+. This will be “a more significant change to American healthcare markets than any other single thing we’ve done, by shining light on the costs of our shadowy system and finally putting the American patient in control,” he said.

According to CMS, the executive order for Improving Price and Quality Transparency in American Healthcare outlines two rules designed to empower patients, and will take effect January 1, 2021. 

  • Price Transparency Requirements for Hospitals to Make Standard Charges Public, Final Rule

    All hospitals operating in the U.S. will “establish, update, and make public a list of their standard charges for items and services they provide.”

  • Transparency in Coverage, Proposed Rule

    Real-time access to cost information, including estimate of patients’ cost-share liability, through an online tool in order to shop and compare costs before care.

    It also requires that providers disclose, on a public website, the negotiated rates for 300 common, shoppable services (like x-rays, outpatient services, lab work, or bundled services like knee replacement or a c-section). This would include:
  • Full price before any discounts
  • Cash discounted price
  • Price negotiated with payers
  • The minimum/maximum with all payers

These disclosures are required under the ACA to some extent, but the data is hardly accessible, often too detailed and complicated. This new price transparency ruling aims to fix that by requiring accessibility and clarity by way of prominent publication and use of plain language.

This is what Apostrophe has offered its members all along through our smart shopper program. By selecting smart shopper options, which include high quality, low-cost providers, our members save enough money to result in $0 cost to them. We help them find the best possible rate from quality providers; it’s the difference between paying $2900 for a head CT, or $480 for the same service with the same (or better) results. We’re rewarding our members for making smart healthcare decisions.

That’s exactly what this price transparency ruling aims to do universally. This is a net-positive for employers who want to take control of healthcare costs (which, we imagine, is all of them!). For self-insured employers, this gives you power to help employees put published pricing information to work for both of you.

When price and quality data are available side by side, patients are more likely to opt for lower-cost care from highly-rated providers. In fact, they’re 94 percent more likely to choose the lower-priced option, according to SHRM. This can dramatically reduce healthcare costs for both employers and employees. Communicating the value of this information, and educating on how to use it, falls to the employers. 

Self-insured employers don’t have to wait for a transparency ruling to start saving their company and employees money, though. Contact us to learn more about Apostrophe.