Many healthcare consumer pricing tools still flawed

As hard as some employers and insurers are trying to get consumers interested in online tools for price transparency in healthcare, they might be doing their employees or members a disservice if the services don’t provide accurate, relevant data, two long-time transparency advocates say.

Writing on the Health Affairs blog, Susanne Delbanco, PhD, MPH, executive director of Catalyst for Payment Reform, and François de Brantes, MS, MBA, executive director of the Health Care Incentives Improvement Institute, argue that “many price transparency tools suffer from one or more common methodological flaws.”

According to Delbanco and de Brantes, some quote prices for procedures but have “incomplete definitions” of what constitutes a “medical episode,” leaving out, for example, outpatient rehabilitation from the true cost of hip replacement surgery.

Online pricing tools should be capable of helping consumers determine what care is necessary and what is unnecessary—and not just to avoid overtreatment. “If the tool doesn’t parse out what is included in the price estimates, the consumer may end up picking a low-priced provider who doesn’t perform needed tests,” the two wrote.

Plus, Delbanco and de Brantes added, some comparison tools draw on too small of a sample to be reliable. “In trying to compensate for small sample sizes, some vendors may use multiple years of historical claims data to derive average episode or service prices. However, these prices may not reflect currently negotiated rates,” they said.