Statement From Health Care For All's Executive Director Amy Whitcomb Slemmer Regarding Transparency and Purchaser Incentives to Promote Value

Monday, October 5, 2015


BOSTON – “We believe that consumers have to be at the center of the conversation when it comes to cost and quality of health care.

“Health care consumers are concerned about increasingly high out-of-pocket expenses.  Last year, commercial insurance coverage increases were held to 2.6% for an average of $446 per member per month, but the member cost-sharing rose by 4.9%, with no better quality or additional benefits.  Consumers are directly feeling these increases, which in turn can create real barriers to care.

“We appreciate the steps that the state and other stakeholders are taking to address health care costs, and we see room for improvement. We have particular concerns with the call for increased use of current tiered network and high deductible health plans as tools to reduce costs.

“In theory, tiered network plans create incentives for health care providers to deliver high quality, cost efficient care, and for consumers to select these high-value providers. In reality, however, tiered networks have proven to be opaque and confusing for both patients and providers.  Inconsistent tiering methods combined with a lack of transparency make it difficult for patients to make informed choices about where to seek care based on cost and quality data.

“Similarly, high deductible health plans can present real challenges, particularly for those with limited financial means. Patients are often not able to discern between appropriate and inappropriate care in response to increased cost-sharing. For vulnerable populations, these plans simply shift costs and can force patients to reduce necessary services, which in turn results in adverse health outcomes that are more expensive to treat.

“Instead, plans should promote value based care while simultaneously addressing the barriers of high out-of-pocket expenses. For example, HCFA supports the ‘No-Copay’ bill, a legislative effort to eliminate cost-sharing for select high-value services and medications most effective for the management of chronic diseases such as asthma and diabetes. This bill would maximize adherence to effective medications and treatments, while reducing expensive medical costs like hospitalizations.

“Health Care For All knows that the ‘cost and quality’ equation is hard to navigate for consumers. A 2014 survey found that half of Americans associate higher health care prices with better quality, while other surveys have found the opposite -- over 70% of respondents saying higher prices are not typically a sign of better-quality medical care. However, in the absence of other usable signals of quality, consumers tend to rely on cost as a proxy or on the reputation of a provider.

“Consumers need access to cost and quality tools to be able to make informed decisions, and this information has to be relevant, clear and actionable.

“Over the last three years, institutions have begun to comply with new transparency requirements. However, we see room for improvement and call on state agencies to ramp up those efforts, focusing on the core principles of consumer education.

“This need is highlighted in our 2015 Consumer Cost Transparency Report Card, where HCFA assessed the consumer cost estimation tools of the state’s three largest insurers in the categories of aid in decision-making, accessibility, and comprehensiveness.  The average grade received was a C-. Our interviews with consumers who evaluated the sites also found that almost none would return to their insurers’ tool if they needed cost information.

“We appreciate the opportunity that the Health Policy Commission provides to state agencies, providers, insurers and consumers to share data and showcase innovative cost containment models during the Cost Trend Hearings. We continue to hear every day from consumers who struggle to maintain their health care coverage and keep up with rising out-of-pocket costs.  We believe these conversations promote cooperation among all the stakeholders, and we urge that how consumers experience cost be front and center as we consider solutions that improve the health care system for all of us.”