W^H? The Holmes Murphy Blog

  • Healthcare Price Transparency: What About Contextual Transparency?

    Like many of you, I keep track of what’s happening in my neighborhood via the much-maligned Nextdoor app. In between photos of porch pirates and heartfelt entreaties to stop dogs from using someone’s lawn as a latrine, I’ve noticed the following kinds of exchanges.

    Newbie: Hi, I’m new to the neighborhood and I just love living here. I’m looking for a good (insert type of medical specialist here) close by. Does anyone know one?

    Longtime Resident: Oh, sure, you should go see Dr. X. She’s wonderful – treated my mom last year and we couldn’t be more satisfied.

    Other suggestions follow, but I wonder what the new resident has really learned. After all, we don’t know what this person is looking for in a physician. Is it a warm bedside manner, a short waiting period during office visits, a successful outcome to a surgery, or a reasonable copay?

    In the same manner, the newbie has no idea what the other resident thinks makes a good doctor. Is it awards, a specific medical school, years in practice, etc.?

    Healthcare Price Transparency

    Enter transparency, the latest of all buzzwords in the health insurance realm.

    There are a variety of laws and regulations requiring health plans, health insurers, and even pharmacy benefit managers to offer consumers a wealth of information regarding pricing. There’s transparency in:

    • Pricing
    • Mental health transparency
    • RX transparency
    • Surprise billing protections
    • Additional information on ID cards
    • Price comparison tools
    • Shoppable services
    • and more

    While these requirements have many different compliance dates, the tools involved are designed to empower the consumer and make prices for any service more visible. That is a laudable goal. All things being equal, I’d rather pay $500 out of pocket for an MRI as opposed to $1,500.

    Contextual Transparency

    But if I’m interested in learning who the best doctor is to perform a surgery or diagnose a difficult dermatological infection, how do I do that?

    “Hey, Dr. Smith was selected as The Magazine’s Top 100 Doctors of 2021!”

    “Gee, my neighbor recommends Dr. Jones, who went to the local university!”

    “Oh, my PCP recommended Dr. Roe because they’re in each other’s referral network!”

    There’s even entire category of Reddit posts entitled “how do I choose a doctor?” None of these are necessarily good methods of physician selection.

    According to a 2014 survey from The Associated Press and the NORC Center for Public Affairs Research, more than half of Americans focus on personality and relationship when choosing a physician. Only 29 percent said delivery of care or the patient’s health outcome was the most crucial. To me, that’s surprising. I don’t care if the surgeon is warm and fuzzy; I want those good outcomes.

    While healthcare pricing transparency is a tremendous start (and a much-needed help to those of us wanting to use our healthcare dollars wisely), I’d like to see the next step be transparency with context. Tell me how much something costs, and then tell me if it’s worth it. While I can judge for myself whether I want to spend the money for a Cadillac or a Kia, I can’t judge whether spending more money on a particular physician will work to my advantage.

    Dollars and cents are important, but dollars and sense is what I’m looking for in any useful consumer tool. We can look forward to the implementation of healthcare price transparency and its related services relatively quickly. Right now, we can only dream about a day when we will have context alongside that transparency, and consumers can make truly informed decisions.

    What questions do you have on this? I’d love to hear from you. Just reach out!

    Published on: 09.30.21

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Healthcare Price Transparency: What About Contextual Transparency?