Health care continues its mission to use data to increase transparency, lower costs, improve quality and enhance patient choice and satisfaction. Patient information in the electronic health record (EHR) is currently being leveraged to generate patient-specific information for the costs of drugs covered under a patient’s drug benefit; the costs of drugs, devices and services covered under the patient’s medical benefit; along with the status of patients’ specialty medication prescriptions.
These twists on transparency are relatively new, owing to advances in technology and emerging use cases. Transparency has traditionally meant having providers inform patients about the procedures they offer and their associated prices. That trend is certainly alive and well. We see this most recently in the hospital transparency final rule from the Centers for Medicare and Medicaid Services (CMS). Beginning January 1, 2021, hospitals must post payer-specific negotiated rates for 300 services online in a searchable and consumer-friendly manner. Armed with this information, CMS believes that patients can shop around for the best deal on a specific procedure; at the same time, this is expected to lower costs through competition.
New use cases are driving change.
This final rule arose as new use cases were emerging concerning the need for additional price transparency based on a patient’s insurance coverage information available in the EHR. Two stand out.
The first is the increase in adoption of value-based care reimbursement models, which reward providers for improving quality and lowering costs. Several studies have found that having information on the costs of patient care helps guide physicians toward more cost-effective care with better outcomes. For example, a 2018 study found that having cost data was an influential factor in helping physicians select a particular therapy and physicians reported that they welcomed the information. The study also indicated that increased data access was directly related to improved outcomes, which hits at the heart of the value-based care model.
A second driver for increased transparency is the response to the coronavirus disease 2019 (COVID-19) crisis. Many Americans are feeling the financial squeeze caused by these responses to the pandemic. Many lost their incomes and health insurance, while countless businesses struggle to survive in the aftermath. According to one survey, many consumers will select care differently in a post?COVID-19 world, with the need for higher quality, lower cost and more accessible care options at the top of everyone’s list. In addition, adults increasingly are concerned about the costs of health care—more so than they were before COVID-19. Price transparency — especially on a patient-specific basis — will be a must have for both patients and providers going forward.
New kinds of patient-specific…
Read More: Achieving Patient-Specific Price Transparency by Unlocking EHR Data