Few patients making use of price transparency tools

Two studies published in the August edition of Health Affairs emphasized while patients like the idea of having healthcare prices available for comparison shopping, in practice, few actually take advantage of the tools.

The first such study examined the behavior of people covered by the California Public Employees’ Retirement System (CalPERS), which manages health and retirement benefits for public employees and their dependents in the state, along with retirees. The self-insured system is administered by Anthem Blue Cross. Beginning in July 2014, those in a preferred provider organization (PPO) plan were offered a price transparency tool called Castlight, which allowed them to compare prices and out-of-pocket spending for services at in-network providers.

Utilization of the tool was low. By September 2015, only 12.3 percent of those offered the tool used at least once, while 2.4 percent had searched with it at least three times. The researchers then looked at whether searches for lab tests, office visits and advanced imaging services for which price information was available were followed by visits to lower cost providers. Only a small percentage of claims from CalPERS enrollees offered the tool were preceded by a price search: 0.3 percent of lab test claims and 1 percent of both office visit and imaging claims.

“Price transparency tools may result in lower prices for a selected set of services, but the tools have little impact on overall spending because of the small percentage of people who use them,” wrote Sunita Desai, PhD, a fellow at the Harvard Medical School and coauthors.

In a separate study led by Harvard health care policy and medicine professor Attev Mehrotra, MD, MPH, researchers surveyed nearly 3,000 nonelderly patients who had received medical care in the previous 12 months. While more than half (52.1 percent) of respondents were aware of prices before receiving their care—with lower awareness among patients under age 30—fewer than 13 percent who had to spend out-of-pocket in their last healthcare encounter sought information about prices before receiving care, and only 3 percent had compared costs across providers.

While the younger demographic had lower awareness of the price (37 percent for patients between ages 18 and 29), they were the most likely to act on the information, with 15.6 percent reporting they considered going to another provider and 7.8 percent comparing costs across providers.

Still, the overall utilization was low, even though most respondents were in favor of more people shopping for their care and didn’t equate higher prices to higher quality care. Mehrotra and his coauthors called this a “striking” result which may be explained by several barriers: patients not knowing how to obtain price information, needing complex information like specific procedure or diagnosis codes and being constrained by narrow insurance networks, lack of provider availability or an unwillingness to switch providers.

“Our results emphasize that simply passing price transparency laws or regulations (as over half of states have done) appears insufficient to facilitate price shopping,” the study concluded. “Price information must be more accessible and comprehensible to patients. However, our results show that even if the information were more easily accessible, patients’ preferences to maintain provider relationships and efforts to coordinate care would limit overall rates of shopping.”