DOI Gets $5.2 Million Grant From HHS
The California Department of Insurance (DOI) has received a $5.2 million grant from the U.S. Department of Health and Human Services to push healthcare price transparency among both medical providers and payers.
The DOI will use the funds over the next two years to establish a data center that will collect and disseminate healthcare pricing data to Californians.
The HHS announced $87 million in funding for a nationwide effort last May, not long after journalist Steven Brill published a lengthy article in Time magazine discussing how hospitals virtually disregard their chargemasters in how they bill patients, particularly those who lack insurance.
"Consumers today are unable to compare prices for doctors, hospitals, and other medical providers because price information is simply not available," said Insurance Commissioner Dave Jones. "Even with (the Affordable Care Act), consumers still face significant out-of-pocket medical costs including deductibles and co-payments. Providing consumers greater access to medical provider pricing before they seek care could be a real game changer.”
Hospitals in California have mostly objected to legislative efforts to promote price transparency, and only a few organizations have posted any pricing information, typically for a limited number of procedures.
The DOI will work a yet to be named academic or non-profit institution to establish a public database that collects and aggregates claims data and categorizes it by episode of care. Consumers will be able to use the data to compare providers on both cost and quality.
The Centers for Medicare & Medicaid Services earlier this year published a pricing database for the 100 most common medical procedures performed in hospitals throughout California and the rest of the nation. However, the size and breadth of the database makes it challenging for a consumer to use.
“This data and new data centers will help fill that gap,” HHS Secretary Kathleen Sebelius said at the time the CMS database was established.
Private entities have also been making some limited progress in creating pricing transparency.
A firm based in Utah, Pricing Healthcare, has posted limited pricing for a handful of providers in the Bay Area using data available from the Office of Statewide Health Planning and Development and from patients who have submitted their claims data. Chief Executive Officer Randy Cox said he expected a wider range of prices for Bay Area providers to be posted to his firm's website by the end of the year.
Jones noted that California's grant from the HHS would have been $400,000 greater if his agency had the right to regulate premiums charged by health insurers. A ballot measure that would give his office that power will likely be voted on in November of next year.
