Transparency in healthcare is like the weather in the Mid-West. People talk about it all of the time but no one ever does anything about it.

To have any success at lowering healthcare costs and reducing premiums, we need Transparency in every facet of healthcare delivery so let’s do more than talk about it!

Sorry to trample on an ages old saying but don’t you agree that we need transparency in every facet of healthcare delivery. Today let’s address two areas: carriers and providers.

First, let’s review definitions of transparency because sometimes what us common folks think something means is different in Washington DC or in an insurer’s board room. To be thorough let’s look at Transparent & Transparency as either Noun or Adjective.
In other words, let’s cover our bases.

Adjective: Transparent

  • allowing light to pass through so that objects behind can be distinctly seen as in “transparent blue water”

Synonyms:  obvious, evident, self-evident, unconcealed, crystal-clear

Noun: Transparency

  • the condition of being transparent, “the transparency of ice”

synonyms: openness, accountability, straightforwardness, candor,
“the new government aims for better transparency”

Okay okay, stopping smirking. We all know that there is very little transparency in our current healthcare delivery system and even less in Washington D.C. but at least that is thoroughly “transparent” for all to see. Sorry!

Let’s point out just a few of the many benefits transparency would provide:

  • Everyone would be better shoppers for healthcare because they could see prices.
  • Costs for healthcare services would be reduced due to competition
  • Premiums would be lower or at least honestly competitive.
  • Plans could be built to accommodate our individual needs.
  • There are many more but I’ll stop there!

The actions suggested below may sound somewhat simple but rest assured that these two industries, Providers and Insurers, will fight any measures to divulge information to the public. As we said above, people will talk about transparency and its many benefits but no one wants to be the first or the only part of the healthcare delivery system to put it information out for the public.

We’re going to address insurers and providers first.To be fair, these two groups include commercial organizations trying to hire and employ fellow citizens therefore they must be profitable to exist. Profitability is part of the US economic system that creates goods and services by employing millions of people. So any actions that might harm the business must be explored carefully even if it might be for the benefit of many.

Let’s start with what Insurers and health plans can share without the loss of proprietary information that they believe gives them market appeal.

  • Loss ratio on each employer group plan. (regardless of group size)
  • Loss ratio by health plan by state.
  • Cost of care by Service code for every provider in its PPO.
  • Variance of Insurer’s PPO cost compared to Medicare allowance.

Now let’s look at providers. The internet is full of information about transparency in healthcare. Most of it is thoughtful well intended data that if implemented would make a difference. I won’t even begin to list all of the suggested actions.
Let’s identify a few items that providers and facilities can share:

  • Cash price of any service for specific service codes ex: hip replacement.
  • Medicare allowed price for specific service codes
  • Number of each specific service provided in previous 2 years, ex: hip replacements.
  • Outcome statistics by services performed.
  • List PPOs accepted
  • List HMOs accepted
  • That’s just a couple

There are some highly regarded healthcare organizations around the country that advertise the price of their services. As a result, I’ve read countless stories of members traveling, for example, to Arkansas for Orthopedic services at greatly reduced costs. Because of those stories, there are just as many patients not needing to travel for their surgical care when their local provider discovered that the patient was willing to travel for savings.

These provider organizations are making their prices available for the purpose of attracting business while delivering quality care and being profitable. If we could integrate insurer info with provider info with incentives for members to make wise decisions the outcome is predictable. We could see competition on an entirely new level that would bring cost down while delivering high quality care. Should we try it?

The topic of transparency is tricky because every business thinks it has secrets that give it an advantage in its market place. But small non-intrusive steps would get it started.

Thanks for the emails this past week. We are getting some great feedback and need it to keep it going.
Remember, we are all in this together.

Mark Reynolds, RHU

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