Today we live in the age of information. Modern technology is abundant, providing many with access to a wealth of knowledge and resources. With so much information at our fingertips, we can easily learn more about many of the choices we face in daily life and compare the available options.
For instance, a shopper in the market for an umbrella (which those of us in California have finally needed again) can easily understand her options using powerful Internet search engines that instantly generate endless webpages, videos, and images. She can access an online marketplace to compare hundreds of umbrellas by feature, color, manufacturer, and price, while also having access to quality ratings in the form of stars and written reviews. Such in-depth but quick comparisons are at the consumer’s fingertips.
However, when this savvy shopper tries to apply the same process to find a health care provider for low back pain, she is less successful. Instead of countless webpages with a host of information at her disposal, she is limited to one site offered through her insurer and/or employer. Instead of easy-to-understand comparison points and quality ratings, the site provides medical information that can often be difficult to interpret.
A consumer who yesterday easily chose a $14 yellow umbrella with a 4.5 star quality rating in 15 minutes is now frustrated and wonders why shopping for health services is vastly different from the retail experience. She needs a comprehensive online marketplace that guides her to the care she needs (and away from unnecessary care) and allows her to compare hundreds of providers by location, price, network status, and quality.
The Evolution Of Transparency Tools
With high expectations regarding the availability of information, consumers are baffled why something as seemingly simple as comparing providers on price and quality is so difficult. As an increasing number of consumers enroll in high-deductible health plans and tiered networks and assume more financial responsibility for their care, the lack of adequate tools is an obstacle to effectively managing health care and associated costs.
However, it’s important to note that today’s transparency tools, and the quantity and quality of data they provide, have come a long way. As consumer and industry needs have shifted over time, transparency tools have evolved to try to keep pace, and we have witnessed an expansion in their capabilities. For instance, in 2012, when Catalyst for Payment Reform (CPR) first released specifications for the evaluation of transparency tools, we identified the need to look for whether price and quality information were both available and displayed simultaneously. Today, this feature is nearly ubiquitous.
However, we are still pushing for toolmakers to make further strides, including creating overall value ratings that help consumers identify their “best buy” when shopping for care. In evaluating tools, it’s now less critical to assess the inclusion of a number of basic features, and more important to look for specific, targeted features that will best help a given population find and use the information provided.
There Is Still More Work to Be Done
While tools aiming to make health care quality and price information available to consumers may not ever provide ‘the total Amazon experience,’ there are some key features they must possess to move these tools meaningfully in the right direction. Our latest specifications highlight a continued need for transparency tools to:
- Be widely available to consumers in most markets and for most insurance products;
- Accurately display a consumer’s real time financial liability, including any remaining deductible, copays, and out-of-pocket maximum;
- Accommodate a variety of benefit and network designs;
- Incorporate priority quality measures and patient-generated reviews in quality scores;
- Combine quality and price into an overall value rating;
- Show prices that are as accurate as possible;
- Allow consumers to tailor search results to their personal preferences (e.g., location, quality, price); and,
- Be paired with consumer engagement strategies to ensure information is not only available, but acted upon.
Better Tools May Not Translate To Widespread Use
The transparency market is working to catch up with the demand created by the increasing number of consumers who need to shop for health care providers and services. However, even as tools evolve to meet their needs, user engagement tends to be low.
This trend seems to be in contrast to the apparent increase in consumer price seeking behavior and desire to use price and quality information. According to a recent survey by Public Agenda, 56 percent of consumers reported trying to figure out their out-of-pocket expense, or how much their insurer pays a provider, prior to receiving care. Furthermore, when seeking price information, 21 percent of consumers tried to compare prices across multiple providers, and 69 percent of consumers believe a website showing how much different providers charge for care would help them to better manage their health care spending.
This gap between the desire for the retail experience in shopping for health care services and the utilization of available transparency tools is puzzling; the very consumers who want the information the tools provide may not be using them. This phenomenon may have to do with poor or inadequate communication to the consumer about the availability of information, where it is located or how to use it. Consequently, when it comes to price and quality data, availability of information may not yet be translating to better consumer decision making.
Thus, there’s room to improve how the market connects consumers to the information they need when they need it. Are convenience and a smooth consumer experience enough to make a positive difference in the uptake and utilization of these tools? For instance, a tool that is seamlessly integrated into the insurance plan, and which reflects our shopper’s benefit design, could enable her to search for providers treating low back pain based on both in-network status and cost and quality tier as outlined in her health insurance plan. The tool is making relevant information passively available to our shopper at the right time. Is this enough?
Or, alternatively, is it necessary to use engagement strategies to drive proactive utilization of the tool? For example, our umbrella shopper is offered a gift card worth up to $150 if she uses the available transparency tool to select and make an appointment with a provider, an approach similar to one used by Priority Health. Enticing engagement strategies and other educational activities such as this can help ensure consumers are gaining access to available information at the right time and incorporating it into decision making.
With the continued rise of high-deductible health plans and other “consumerism” models, we can expect to see the market respond to consumer needs and behavior. However, in the meantime, employers and other health care purchasers on the buy side of the market must continue to choose tools carefully to try to meet the needs of their populations.