A Glimpse of the Holy Grail for Healthcare Cost Transparency

Imagine being told which car or computer you must buy and just forking over whatever it costs. Whether paying full freight or only a portion, would you simply write a blank check?

American healthcare consumers have been doing this for decades, even as the cost of healthcare and the consumer’s share of it continue to climb. Thankfully, blank checks may soon be replaced with dollar amounts that reflect the lowest-cost, highest-quality care a person chooses.

Consumers have long sought this capability, and yet transparency into medical and pharmacy costs is only now beginning to take hold. It took innovative technologies and federal mandates to get us this far, and there’s still a long way to go. But the progress is encouraging.

Same Procedure, Less Pain

By now, we’ve all seen or heard examples of vastly different charges for common medical procedures from one provider to the next. You know, the MRI that’s $2,500 at one facility and $250 across the street. Why would a doctor or health plan send you to anyone but the lowest-cost reputable provider?

Why is a subject for another day. For now, here’s the what: Most consumers still don’t know that huge price disparities can exist. Even fewer have an easy way to estimate out-of-pocket costs and compare between in-network providers.

Not long ago, our company health plan’s carrier began offering a digital resource that enables such capabilities.

Cost comparisons between providers for routine diagnostic medical imaging, as viewed through Sapphire Digital
Actual reported cost estimates for routine diagnostic imaging across various providers in the RxSS health plan network. (Provider names obscured.)

As patients often discover by surprise, the costs for many procedures can include separate physician’s fees, anesthesiology charges, and perhaps hospital-administered tests and medications. Those charges currently aren’t shown in the tool. However, if you search enough different procedures, you get some indication how certain providers and facilities might rank on the cost spectrum.

Is any provider’s medical imaging dramatically better than another’s? Probably not, but some knee surgeries are no doubt better than others. How can consumers factor quality into their provider decisions?

Physician-rating services like HealthGrades, WebMD, U.S. News and others are widely available. Reviews by patients are important, but they are subjective and variable. Quality rankings based on objective, clinical outcome criteria are much less accessible. When tools like the one our health plan offers can integrate both types of measurements along with estimated costs, then we’ll really have something.

Frequency Facilitates Pharmacy Transparency

It’s doubtful anyone could research any costs from the back of an ambulance. On-demand medical cost transparency in emergencies may never happen. With planned procedures and especially prescription drugs, however, most people have the luxury of time and technology. The majority of prescriptions are filled repeatedly for months or years on end, offering ample time and opportunity to make informed decisions at any point.

This is where Rx Savings Solutions comes in, and our carrier realized early on the value of giving members transparency into out-of-pocket prescription costs, as well as:

  • Suggested lower-cost options for any medication being taken, and the ability to look up costs and covered alternatives for any new prescription
  • Proactive outreach and engagement to notify members whenever such options exist
  • Easy ways to change to a suggested lower-cost prescription, drug form, or pharmacy in one click—even if doctor approval is required

(Yes, at RxSS we get to “eat our own dog food,” as they say.)

The user interface dashboard in the Rx Savings Solutions member portal, showing prescription savings opportunities
The RxSS (demo) member dashboard, accessed by single sign-on (SSO) through our health plan’s member portal.

Who knows how long Americans have been unknowingly paying more than necessary for prescription drugs and medical care . Seemingly since the beginning of time, we’ve rarely known what a doctor visit, medical procedure or medication will cost us until it’s time to pay.

Fortunately, things are starting to change. The ability to know costs and compare options for both medical care and prescriptions is valuable and powerful. When transparency and decision support tools can share critical health data between them, along with comprehensive quality metrics, we might finally find the Holy Grail.

Most consumers don’t have access yet, but we’ve seen a glimpse of what medical + pharmacy cost transparency can do. We need more of it. And no more blank checks.

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