Cost Transparency Can Lead to Better Consumer Decisions

Robin Gelburd, President of FAIR Health, gave the keynote presentation on Friday at the NAMCP Fall Managed Care Forum. Her presentation, “Cost Transparency: How Educated Consumers Are Driving Change,” covered a number of reasons that illustrate why data transparency can lead to a chain reaction involving better consumer decisions and lowered costs.

As consumers are being asked to take a more active role in paying for healthcare, there is also an increasing prevalence of high-deductible health plans and health savings accounts. Out-of-network reimbursement models are also evolving, making things even more difficult for consumers that are also dealing with a challenging economic climate. Unfortunately, says Gelburd, consumer education is not keeping pace with these changes. A lack of sufficient tools to help consumers make educated decisions makes it even more difficult to understand a healthcare reimbursement system that many are uneducated on to begin with.

For the aforementioned reasons, Gelburd, previously a General Counsel of a medical research foundation comprised of approximately 30 premiere academic medical centers, hospitals, and research institutions in New York, joined FAIR Health at it's incenption afterwards. The mission of the organization is to provide “transparent, current, and reliable healthcare charge information,” by offering “unbiased data products and services to consumers, the healthcare community, employers, unions, government agencies, policymakers, and researchers.”

The benefits to transparency of health information is obvious, according to Gelburd. Access to cost data can help facilitate better decision making while also helping to manage costs. FAIR Health helps its members understand EOBs; makes cost data available to members prior to them making an in-network/out-of-network decision; and reduces calls to benefits staff and plan member services areas.

Some large insurers already offer tools to their plan members to help them better understand costs before seeking care. Others approach consumer education by posting articles and videos on healthcare reimbursement so that members can better understand, for example, high-deductible health plans, in-network vs out-of-network, and other factors to consider when choosing a health plan that works best for them.

FAIR Health continues to work toward providing transparent data to all stakeholders within the healthcare industry. They have information on 15 billion billed procedures from 2002 to today. They have data contributed by payers representing more than 129 million covered lives. Their data are used by organizations that touch up to 190 million patients. And finally, their website has been honored by the White House Summit on Smart Disclosure. In an era where consumers are being asked to make more choices, and in some cases are even provided incentives to improve or maintain their health, it makes sense that all possible data are presented accordingly. After all, better (and more) information will undoubtedly lead to better decisions and, ultimately, lower costs.