New Hamp­shire web­site re­duces sticker shock for pa­tients

Modern Healthcare - - NEWS - By Beth Kutscher

While New Hamp­shire is a test case for price trans­parency, its ex­pe­ri­ence is lim­ited by a lack of hos­pi­tal com­pe­ti­tion.

Many view price and qual­ity trans­parency as fun­da­men­tal to mov­ing the U.S. to a true con­sumer-driven healthcare mar­ket. New Hamp­shire started down that road a decade ago, and the state, re­cently rec­og­nized as the na­tion’s trans­parency leader, of­fers lessons to other states that aren’t as far along.

Its ex­pe­ri­ence sug­gests that pub­lish­ing the rates in­sur­ers ac­tu­ally pay providers can have an im­pact on pay­ment ne­go­ti­a­tions.

The price trans­parency ini­tia­tive also has en­cour­aged new health plan ben­e­fit de­signs that are send­ing con­sumers to lower-cost care set­tings, and has prompted hos­pi­tals to of­fer pa­tients lower-cost care set­tings.

While New Hamp­shire is a test case for price trans­parency, its ex­pe­ri­ence is lim­ited by a lack of hos­pi­tal com­pe­ti­tion. Only two cities, Manch­ester and Nashua, have more than one hos­pi­tal; the whole state has only about 30 hos­pi­tals and three ma­jor com­mer­cial in­sur­ers.

And, by fo­cus­ing so far on about 40 healthcare ser­vices, the state-run price web­site, NH HealthCost, doesn’t tell the whole story on how hos­pi­tals com­pare on price. “It’s just a piece of all the work and all the ser­vices (hos­pi­tals) pro­vide,” said Paula Minnehan, vice pres­i­dent of fi­nance and ru­ral hos­pi­tals at the New Hamp­shire Hos­pi­tal As­so­ci­a­tion.

Ear­lier this month, New Hamp­shire was the only state to re­ceive an A grade in the an­nual re­port card on state trans­parency ef­forts is­sued by the Cat­a­lyst for Pay­ment Re­form and the Health Care In­cen­tives Im­prove­ment In­sti­tute.

The state has an all-payer claims data­base, the Com­pre­hen­sive Health Care In­for­ma­tion Sys­tem, known as CHIS, which was es­tab­lished by state law. It now is a na­tional leader in pro­vid­ing in­for­ma­tion to con­sumers on what se­lected healthcare ser­vices will cost.

Based on claims data from CHIS, NH HealthCost gives con­sumers an es­ti­mate of what their health plan pays for a ser­vice and what their outof-pocket cost would be. Colorado, Maine and Ver­mont have also cre­ated claims data­bases and are try­ing to let con­sumers look up ac­tual prices. North Carolina re­cently be­gan pub­lish­ing cost data sub­mit­ted by hos­pi­tals on 100 com­mon in­pa­tient ser­vices, 20 sur­gi­cal pro­ce­dures and 20 imag­ing pro­ce­dures, in­clud­ing the ac­tual prices paid by public and pri­vate in­sur­ers.

NH HealthCost went live in Fe­bru­ary 2007. The site uses a bun­dled ap­proach that tries to re­flect the true cost of a ser­vice, for ex­am­ple, the tech­ni­cal part of per­form­ing a mam­mo­gram and the ra­di­ol­o­gist’s fee for read­ing it, said Tyler Bran­nen, a health pol­icy an­a­lyst for the New Hamp­shire In­sur­ance Depart­ment. It’s con­tin­u­ing to add prices for more ser­vices.

Nearly 2,800 peo­ple vis­ited NH HealthCost in the last quar­ter.

Although the site was built for con­sumers, in­sur­ers and providers have been its most at­ten­tive au­di­ence. A study last year by Math­e­mat­ica Pol­icy Re­search found at least one case where a higher-cost provider had to lower its rates be­cause of the data. In 2010, An­them Blue Cross and Blue Shield, the state’s dom­i­nant in­surer, threat­ened to ter­mi­nate its con­tract with Ex­eter (N.H.) Hos­pi­tal, cit­ing rates that were 50% higher than com­peti­tors. Af­ter a well-pub­li­cized dis­pute, Ex­eter low­ered its rates.

Health plan de­signs in New Hamp­shire are evolv­ing faster than in other parts of the coun­try, at least partly be­cause of its price trans­parency, ac­cord­ing to the Math­e­mat­ica study.

Health plans started of­fer­ing in­cen­tives to mem­bers who choose low­er­cost sites of care—such as waiv­ing the de­ductible for se­lect­ing a free-stand­ing am­bu­la­tory surgery cen­ter rather than a hos­pi­tal-based fa­cil­ity.

In re­sponse, Dart­mouth-Hitch­cock Med­i­cal Cen­ter, Le­banon, and St. Joseph’s Hos­pi­tal and South­ern New Hamp­shire Med­i­cal Cen­ter, both in Nashua, opened their own free- stand­ing surgery cen­ter, the Surgery Cen­ter of Greater Nashua, as a joint ven­ture.

Dart­mouth-Hitch­cock CEO Dr. James Weinstein wrote an Oc­to­ber news­pa­per op-ed stress­ing that con­sumers need in­for­ma­tion not just on price but also on out­comes. His hos­pi­tal pub­lishes both on its site.

One lim­i­ta­tion to trans­parency is that it’s of­ten not pos­si­ble for pa­tients to shop around for the best price and qual­ity, par­tic­u­larly in emer­gency sit­u­a­tions, said Michael Mor­risey, chair­man of health pol­icy and man­age­ment at Texas A&M Health Science Cen­ter.

There also are con­cerns that in mar­kets where prices are trans­par­ent, rates tend to nar­row and av­er­age costs rise, said David New­man, ex­ec­u­tive di­rec­tor of the Health Care Cost In­sti­tute.

Bran­nen said the state wants NH HealthCost to ex­pand its trans­parency pro­gram to en­able em­ploy­ers to com­pare health plan premi­ums and ben­e­fit de­signs.

State law­mak­ers have pro­posed bills re­quir­ing providers to pub­lish their charges, but the state has con­tin­ued to in­vest re­sources in NH HealthCost, Bran­nen said. The web­site has taken pres­sure off providers to post their prices, he said.

Providers and in­sur­ers in other parts of the coun­try are likely to face greater pres­sure for trans­parency, and soon. “Con­sumers are now on the hook for much more of the cost than they used to be,” Mor­risey said. “Even if states don’t do much, the mar­ket will push pay­ers in that di­rec­tion.”

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