The argument that contracted rates for healthcare services are proprietary and confidential was invalidated as of January 1, 2021, when the Trump administration
This is not surprising. As an organization that has been working on price and quality transparency since our founding in 1990, we were cautious about the
It's important to explain why we believe Congress, employers, TPAs, brokers and consultants need to keep working to achieve transparency, while at the same time understanding that transparency alone will not lower healthcare costs without other key actions.
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Lessons learned
After the initial release of machine-readable files (MRFs), some markets saw
Confusion arose about gaps in data availability and how the displayed prices were calculated. Despite this, health systems used the data to justify pricing. Noncompliance and weak enforcement efforts related to MRFs were evident, with only 14 hospitals penalized for noncompliance to date.
An effective enforcement system will need to compare MRF amounts in hospital files to payer files and the amounts given to patients as part of shopping tools and good-faith estimates. Achieving this may require state-federal partnerships.
State efforts
States are better positioned than the federal government to ensure accurate and complete healthcare price data since it is more likely that a state can recognize and investigate these types of issues, agree on a resolution and enforce compliance in a timely manner.
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Another point worth mentioning is that state laws would give states the authority to impose penalties, audit information and investigate complaints. Several states have introduced
Quantifying value
Despite the slow progress on price transparency and related challenges, the self-insured employers we work with believe that price transparency is foundational to positive change in healthcare. They understand that achieving free-market principles in healthcare requires understanding prices before services are performed.
Once real price transparency is in place, we can take the next necessary steps to make better sense of our healthcare system. First, we can start to measure value, and once high-value providers are identified, employers can reward them with additional business through strategic network and plan design that steers employees and their family members to highest-value providers for shoppable services.
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Our employer members recognize that it will take more than that to achieve true transparency. They recognize the importance of creating value where it doesn't currently exist. That's why many of them have opened onsite clinics or have strategic partnerships with advanced primary care providers and independent specialty groups that will help patients navigate to affordable care with great outcomes. Care navigation is also vital, and many of our employers are investing in this area.
All steps toward free-market healthcare, from identifying high-value providers to strategic network and plan design, are built on price transparency. We need to work together to advance this policy idea, ensuring lawmakers continue to build upon, improve, enforce, and measure its successes and failures. Keep in mind that there is no guarantee that price transparency will lead to lower prices unless the market is engaged and prepared to use the data to make purchasing decisions.
Get involved
In Wisconsin, Indiana, Texas and other states, employers have joined together to fight for smarter healthcare policies that support free-market principles.
My advice for readers who believe something needs to change in healthcare is to look for a coalition in your state that may already be working on this. There is strength in numbers, especially when it comes to health policy. While change in healthcare takes time, a revolution is underway, and we encourage everyone who believes in positive healthcare transformation to join the battle.
