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Transparency and Reference-Based Pricing

Why Employers Care

Publicly disclosing information about the price and quality of care at the provider and facility levels will enable consumers, employers, and other purchasers to use this information to make more informed decisions about healthcare.

The federal government appealed a U.S. District court decision that would have required the public release of Medicare information on 40 million de-identified patient cases and 700,000 doctors (who would be identified) to a not-for-profit group to create a free consumer database website to determine how well physicians adhere to evidence-based care guidelines.

A U.S. District court decision required the Department of Health and Human Services (HHS) to release physician-specific Medicare information, following Freedom of Information Act (FOIA) requests, for groups to determine how well physicians adhere to evidence-based care guidelines.

Incoming Senate Finance Committee Chair Ron Wyden (D-OR) and Charles Grassley (R-IA) included a provision in major physician payment legislation that would allow the 12 current qualifying entities receiving individual Medicare physician claims data for public reporting to sell non-public analyses to physicians, other providers, and health insurers and certain employers and retirees that meet government-approved criteria to assist with their quality improvement activities.

Separately, Representative Michael Burgess (R-TX) and Gene Green (D-TX) re-introduced a bill that would mandate that States require hospitals to publicly disclose their charges for inpatient and outpatient services and health insurers to provide enrollees with estimated out-of-pocket costs for health care products and services.

Private insurance companies are also providing more information on physician-specific cost and clinical quality information to their members in response to documentation that cost and quality varies widely within networks and regional markets for the same procedure.

The Patient Protection and Affordable Care Act (Affordable Care Act) includes provisions that increase both price and quality transparency. Please see our chart listed below for more information. In May of 2011, Senate Finance Committee members Ron Wyden (D-OR) and Charles Grassley (R-IA) introduced a bill that would make what Medicare pays to individual providers (hospitals and doctors) public beginning in 2013. More recently, Representative Michael Burgess (R-TX) and Gene Green (D-TX) introduced a bill that would mandate that States require hospitals to publicly disclose their charges for inpatient and outpatient services and health insurers to provide enrollees with estimated out-of-pocket costs for health care products and services.

What Can Employers Do?

The National Business Group on Health is a member of Partnership for Value-Driven Health Care, a consortium of business groups and employers committed to improving the nation's health care system by empowering employees to make informed decisions about their health care. Together, members work in partnership with HHS to increase the availability of cost and quality data by requiring health care vendors to publicly disclose this information. For more information or to join the partnership, employers can contact publicpolicy@businessgrouphealth.org.

Members of the National Business Group on Health can also voice their concerns to the Business Group's public policy team and by responding to public policy opportunities to comment on proposed regulations, contact Congress and/or the Administration, testify, or participate in related activities.

Almost 72% of employers responding to the annual National Business Group on Health Plan Design survey, Large Employers' Plan Design Changes, offer online transparency tools to their employees either through their health plans or a third party vendor. The tools provide plan members with meaningful information to choose health care based on quality, value and personal preference.

The National Business Group on Health developed a Transparency Vendor Checklist to help employers and their consultants select and manage transparency vendor platforms.

Relevant Tools and Resources Include:



Page last updated: January 29, 2014

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