Price Transparency in Real Time
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PRICE TRANSPARENCY IN REAL TIME
Health systems continue to respond to Executive Order
Last year, President Trump called for greater price and quality transparency to allow consumers to make more informed healthcare decisions.
Executive Order: On a mission to improve price and quality transparency
1. Empower patients with information
2. Increase transparency to lower cost products and services
3. Enhance access to cost data for innovators, researchers, and providers
4. Improve quality metrics
5. Expand affordable health plan options
Price transparency will continue to underscore healthcare reform. Already, creative cost solutions are popping up across the country as the healthcare industry anticipates federal agency rules, regulations, and guidelines to continue:
1Oregon Health & Science University Health System
Humana and Epic have implemented a unique pricing tool into the EHR system at Oregon Health. The tool automatically factors in cost information (ie, the co-pay price, deductible amounts, and need for prior authorization) not normally available to patients until an official bill is issued. Now, providers can readily compare and contrast “actual” product prices and share this information with patients before the prescription is written
[Executive Order 1, 2, 3]
Increased transparency requires industry partnerships. Health plans have been using formularies to model prices for years, but this data has never trickled down to the patient. Integrating Humana’s IntelligentRx formulary product into the Epic EHR e-prescribing workflow at Oregon Health has merged pricing and provider decision making
2Simplee and Cerner
Partnered to create a billing and payment tool that makes patients aware of their financial responsibility earlier in the treatment process
[Executive Order 1, 2]
3Surescripts
Created a price transparency tool, aptly named the Real-Time Prescription Benefit, which gives providers access to patient benefit information and supplies formulary cost metrics. Uptake of the tool continues to surge
[Executive Order 1, 2, 4]
4MEDITECH and DrFirst
Formulated MyBenefitSolution, another real-time opportunity to access “actual” cost data to enable providers and patients to choose the most valuable therapies
[Executive Order 1, 2, 3]
Results extend beyond lower cost product options
Price transparency tools have the potential to remove much of the administrative burden that accompanies high cost therapies. Better shared decision making between provider, pharmacy, and patient is expected to trickle deeper into health systems to eliminate pharmacy call backs, improve medical adherence and patient-reported outcomes, and lower overall costs — leaving more time for critical clinical conversations.
What’s next?
Connecting patient benefit information with product cost earlier in the process is an important first step toward value. However, determining the “actual” price of healthcare services will require more players, more openness, and likely more regulation. Opportunities to expand affordable health plan options (Executive Order 5) will be high on the to-do list for 2020.
How can we help you find your way in to proactive price transparency through strategic partnerships?
