Is Healthcare Ready for a New Era of Transparency?
By Miriam Paramore
Miriam Paramore is president and chief strategy officer of OptimizeRx of Rochester, MI.
It’s not only patients who are demanding greater transparency around healthcare costs. It’s physicians and state and federal government officials. In just one year – January 2021 – a new federal rule will go into effect that requires all hospitals to post standard charge information, including discounted cash prices, payer-specific negotiated charges, and charges for at least 300 “shoppable” services, such as imaging, lab tests, and outpatient visits.
The rule, and associated rules for insurance companies, point to a new era of transparency driven by deepening healthcare consumerism. Increasingly, patients will be armed with data that allows them to guide their healthcare decisions in coordination with their healthcare providers, ultimately leading to more patient-centered care.
But this transparency also changes the patient-provider relationship. It’s never been more important to give both patients and doctors tools to navigate care options efficiently, allowing them to work together to make the best healthcare decisions, personalized to each patient.
The hard truth is that out-of-pocket healthcare costs for consumers continue to soar, creating notable financial burdens for patients and negatively impacting medication adherence and clinical outcomes. Amid continued growth of high-deductible health plans, deductibles alone rose 26% in 2019 from 2008, and expenditures are expected to continue to rise in 2020. Consequently, patients increasingly look to their providers for financial guidance and assistance.
Consider the impact of treatment cost on the day-to-day interactions between physicians and their patients. In May 2019, dermatologist Jack Resneck Jr., MD, chair of the AMA Board of Trustees, testified before Congress in a hearing on high drug prices about the experience of one of his patients. He noted that the wholesale price of the patient’s medications had quadrupled in price over the past 15 years. Faced with a pre-deductible PPO copay of 40%, the patient made the choice to stop his treatment. It’s stories like this one that contribute to rising healthcare costs.
Non-optimized medication therapy, including non-adherence, is linked to $528 billion in potentially avoidable healthcare cost. Notably, the vast majority of patients discuss healthcare costs with their doctors, according to a recent survey of 642 physicians across a variety of specialties. Doctors want patients to take medication that works for their health and their pocketbooks, and they know that one is often dependent on the other.
In the same survey, doctors indicated an overwhelming willingness to engage in these cost conversations with patients. Eighty-six percent of physicians surveyed indicated that they are comfortable discussing health care costs with patients, and over 90% believe they have a role to play in discussing healthcare costs with patients.
So how does the healthcare industry make these conversations part of standard practice? New platforms that build on healthcare providers’ existing electronic health records to streamline the reams of data – pharmaceutical options and costs, drug compatibility and patient adherence – are an important piece of the puzzle. Physicians need access to the data the pharmaceutical industry maintains, such as pricing and saving opportunities, while in the examining room with patients. Digital communication pathways that provide these resources to physicians will facilitate informed discussions that will ultimately drive a patient’s decision to follow through on recommended treatment.
Greater transparency is better not only for patients, who will have the opportunity to work in concert with providers to get the healthcare they can afford, but also for doctors, who will have access to the drug cost information their patients are requesting and to increase the likelihood of their patients following through on recommended care. Doctors already know that discussing drug cost is essential: 73% of physicians in the survey indicated that they feel the patient’s responsibility for cost is important when making a prescribing decision.
Digital tools are poised to facilitate this new era of transparency and improve healthcare outcomes and patient and physician success rates. Let’s make sure we encourage their implementation in time to move seamlessly into a patient-centered healthcare future.