Becker's Hospital Review

27 Financial Management I n 2006, Danville, Pa.-based Geisinger Health System decided to take its electronic portal for patients to the next level. The portal already of- fered access to patients' clinical records. However, it didn't provide price estimates. In an effort to make billing more patient-friendly, Geisinger decided to change that, says Kevin Brennan, the health system's CFO and executive vice president of finance. That's how Geisinger's MyEstimate got its start. The tool lets patients use an online estimator to find out how much they'll owe for various servic- es. They can also fill out a form online to receive a price estimate from Geisinger. Both methods take into account the type of health insurance patients have, their individual benefit design and factors such as their year-to-date deductible information. "What the patient would get was the best estimate available for the service that was being ordered for them by a physician," Mr. Brennan says. Like Geisinger, a number of other healthcare pro- viders and payers have responded to the growing push for price transparency by developing tools to let patients obtain cost estimates before they receive treatment. Earlier this year, a task force (including Mr. Brennan) led by the Healthcare Financial Management Association released a re- port on improving healthcare price transparency that offered examples of price transparency tools, such as Geisinger's MyEstimate. Others on the list include tools developed by Maricopa Integrated Health System of Phoenix and the Wisconsin Hospital Association, as well as health insurers Aetna and UnitedHealthcare. As out-of-pocket costs rise and patients continue to take on a greater portion of their care costs through high-deductible health plans, the demand for transparency tools (which can consist of in- teractive websites, brochures and apps, among other formats) will continue to rise, says Richard Gundling, vice president of HFMA. "Everybody who's an employee, every year your co-pay and deductible are just a little higher," he says. "When we talk to patients about being able to have that conversation earlier rather than later about price, it gives the opportunity to maybe have another con- versation with their doctor about treatment alter- natives. It just empowers the patient to have that." Although not all industry experts think hospi- tals should create their own tools, they seem to agree healthcare providers can play a key role in advancing transparency in general and the devel- opment of portals that let consumers obtain and compare costs. Tool development tips Mr. Brennan says Geisinger's MyEstimate aims overall to be patient friendly and make it easier for people to be aware of their financial obliga- tions. He advises other hospitals and health sys- tems looking to provide price information to focus on the out-of-pocket amount patients owe, rather than the "retail price" of care. "We weren't trying to define what the insurer reimbursed us," he says. "We were just trying to solve for the prob- lem we think was most relevant: How much is it going to cost [the patient]?" He also says using the system's electronic medi- cal record system as the foundation for MyEsti- mate helped get the price portal off the ground. "The basic engine was in place — an electronic repository across every single Geisinger site that captured and stored clinical information," he says. "Behind the scenes we also stored financial information in a warehouse. We really challenged ourselves as to whether or not we could leverage that investment with some additional informa- tion technology connectivity." Additionally, Mr. Brennan says price transparency tools should provide quality information to put cost estimates in context. MyEstimate includes links to various sources, such as CMS, for qual- ity information. "It's shame on us if all we do is provide financial information without providing other relevant quality information," he says. "We strongly believe at Geisinger that the real value is a combination of their out-of-pocket consequence and the quality of care that is going to be ren- dered. Some people like to drive a Mercedes and some people like to drive a lower-end economy car. You make your own unique, customized value decision." Andrea Caballero, program director at the non- profit Catalyst for Payment Reform, agrees that cost and quality information must be presented together. "Many of the tools we've seen, you've got price over here, and you've got quality over here," she says. "It's hard to see what that would be to- gether. CPR is very clear that price info alone isn't going to change consumer behavior. It's going to be price information, quality information and benefit design that will drive behavior change." Citing a report CPR released last year on effective healthcare price transparency tools, she says price portals must also be easy to find, use and navigate, as well as customizable for each patient. Should hospitals leave it up to the health insurers? Ms. Caballero says CPR feels hospitals aren't necessarily in the best position to provide each patient's direct cost-sharing information. "Obvi- ously a system where every provider has to build their own tool isn't very efficient," she says. "That's not an angle we really explored or would think is the most consumer-friendly." Will Hinde, healthcare practice director at the business and technology consulting firm West Monroe Partners, agrees health insurers are bet- ter positioned to create transparency tools. He says Making Costs Clear: How Hospitals Can Help Drive Price Transparency Tool Development By Helen Adamopoulos SAVE THE DATE! Becker's Hospital Review CEO Strategy Roundtable November 5, 2014 • Ritz-Carlton Chicago, Chicago 40 Hospital & Health System CEOs Speaking Co-chaired by Scott Becker, Publisher, Becker's Hospital Review, and Chuck Lauer, Former Publisher, Modern Healthcare To learn more visit www.BeckersHospitalReview.com To register, visit www.regonline.com/ceoroundtable2014

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