New Report Outlines Steps for Greater Transparency

In July 2017, The Network for Excellence in Health Innovation (NEHI) released a new report that outlines steps for greater transparency in health care. The report states that helping consumers make well-informed decisions can lead to higher quality of care, greater patient satisfaction and better use of the nation’s health care resources.

NEHI found that most consumers make medical decisions without proper support, after interviewing health care industry experts, holding a discussion with thought leaders, and reviewing existing research.

Choosing a doctor, hospital, health insurance plan, or a course of medical treatment can be overwhelming, and these information gaps in the system cost both consumers and the nation. Their research revealed:

• Consumers often don’t know that they may have multiple treatment options or that health care costs can vary widely for the same service.
• While there are tools to help consumers with the decision-making process, these tools are not consistently available or useful.
• If consumers make the wrong decision when selecting a health plan or provider, there could be expensive consequences.

The NEHI report states that “providing high-quality information to consumers through well-designed tools, as well as other resources to help them interpret that information, can address these issues and empower consumers to make superior choices. Having adequate information can also help to protect consumers from financial surprises, such as learning after the fact that a given provider is out-of-network and that treatment that has already been provided will not be covered by the insurer. The need to address the potential for unwelcome financial surprises is especially important as plans move toward increased cost sharing, narrower networks, and restrictions on pharmaceutical formularies.”

Based on their research, NEHI proposes a nine-step process to help consumers make more informed decisions and provides a number of recommendations. This includes a public awareness campaign, better marketing of the tools available to consumers and policy recommendations for lawmakers.

The nine steps include:

1. Conduct public awareness campaign on choice and its consequences;
2. Increase consumer awareness of tools and resources;
3. Simplify presentation of data with access to greater detail if desired;
4. Customize options presented based on consumer characteristics and preferences;
5. Increase trust through involvement of neutral third parties in tool development and dissemination;
6. Hold plans and providers accountable for data accuracy and protect consumers from the financial consequences of acting on inaccurate or incomplete data;
7. Create tools, payment incentives, and liability protections to encourage providers to engage with consumers;
8. Implement policy changes to broaden the availability of data and tools; and
9. Create and pilot test a common, integrated platform through which consumers can access the full array of tools and resources.

The report concludes that while much of the onus to better engage consumers in decision-making will necessarily fall on health plans and providers, policymakers can also play a key role in making sure that consumers can get the information they need.

Specifically, policymakers can encourage the dissemination and implementation of best practices for creating meaningful transparency tools; implement protections for consumers who make decisions based on inadequate or inaccurate information; build on existing tools at the state and federal level; and incorporate incentives for providers in value-based payment arrangements to support shared decision-making with patients. Research compiled by NEHI suggests that these initiatives could lead to better quality of care, greater consumer satisfaction, and far better use of the nation’s health care resources.