Connecting state and local government leaders
The first iteration will rely on hospital claims data to infer the average costs of various medical procedures.
One of the Center for Health and Information Analysis’ core missions, since the commonwealth government in Massachusetts established it in 2012, is the development of a consumer-facing website making sense of health care costs.
The thinking is, a cost transparency website will improve health care literacy by explaining terminology and ultimately facilitating better decision-making among Massachusetts consumers.
Getting there hasn’t been easy though, as the Massachusetts law that created CHIA also provided for health care plan providers offering similar info—making duplicative information a concern. And CHIA has simultaneously overseen the rollout of new datasets.
“Only more recently have we turned our attention to the website,” said CHIA spokesman Andrew Jackmauh. “But the timing is fortuitous because at the state level leaders are recognizing transparency in health is really important.”
CHIA is looking to other states for inspiration, and New Hampshire’s HealthCost tool stands out—having scored an A on Catalyst for Payment Reform and the Health Care Incentives Improvement Institute’s 2015 national report card grading health care price accessibility. Massachusetts received an F.
Early last year, New Hampshire expanded HealthCost’s library of medical procedures to include physical therapy, behavioral health, dental and additional drug prices. And a new interactive tool sheds light on hospital-quality measures.
Massachusetts’ first pass at its website will present plan-agnostic info on the cost of shoppable healthcare conditions, and a request for quotation was issued in December with plans to select a vendor this month to build the site. Production is anticipated to take several months.
“Health care is so important to people,” Ray Campbell, CHIA’s executive director, told Route Fifty in an interview. “We see a trend of more people paying out of pocket and a rise in high-deductible plans, so it’s front and center and on lots of minds.”
Several Massachusetts lawmakers have expressed concerns that recent budget cuts to CHIA, which The Boston Globe has reported will cost the agency 65 positions in two years, will also hamper the commonwealth’s endeavor to grasp and mitigate rising health care costs.
While “the rightsizing effort last year was difficult,” Campbell said, CHIA “is in a good place” having already collected the data under its statutory authority and leaving web development to the professionals.
The data itself comes from a robust fair claims database, started around the same time as CHIA, that pulls from a majority of payers and requires standardization and normalization. In the past, Massachusetts has analyzed clusters of claims data—what a hospital charges health plans for particular services rendered—to surmise the average prices for various medical procedures.
“We don’t see every single claim in the system, but it’s a good way to get at prices by looking at discrete procedures,” Campbell said. “It doesn’t capture prices perfectly, but it’s roughly accurate.”
Looking at hundreds of thousands of cases and coming up with averages means no individual patient’s personal information is exposed.
A state legislative committee is currently considering whether to grant CHIA the authority to compel hospitals to reveal their prices, Campbell added, which is “a whole lot more direct than building . . . literally millions of encounters happening in the health care system.”
“That would allow us to cut to the bottom line, instead of Sherlock Holmes sleuthing through 150 procedures to get at what are you paid,” Campbell said.
The inferential claims-based approach is not as good at pricing a whole knee replacement as it is the itemized costs involved, but it will stand CHIA’s website up with updates anticipated in the future.
CHIA is considering how to provide consumers with health care quality and safety information.
The Boston-based Betsy Lehman Center already deals with patient safety issues in Massachusetts, and Patient CareLink gathers state hospital quality data. So CHIA is looking for ways to supplement those efforts rather than replicate them, possibly through interfacing.
Campbell also wants to help consumers at different points in the treatment process perhaps find insurance or a doctor specific to their illness.
“People come at this from so many different angles, and their information needs are fairly subtle,” he said.
A positive government response to the website CHIA ultimately puts out could lead to the allocation of more resources for the agency’s work.
“The topic has been growing in importance and buzz and recognition,” Campbell said. “I do think the budget cycle we’re about to go through we’ll probably see some action and more authority, so the world will look more different and exciting a few months from now.”
Dave Nyczepir is a News Editor at Government Executive’s Route Fifty and is based in Washington D.C.
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