Abstract
Given increased enrollment in high-deductible health insurance plans and mandates from the Patient Protection and Affordable Care Act, individualized price transparency tools are needed. To assess accuracy and initial user experience of a cost estimation tool for ambulatory procedures delivered via an online patient portal and informed by real-time data feeds from third-party payers. This quality improvement study included patients aged 18 years and older at an integrated health care system in Northern California. Data from patients who used the cost estimator tool from August 21, 2018, to April 9, 2019, and who had matching explanation of benefits statements were used to assess accuracy of the tool. User experience was assessed with a brief survey completed online or via postal mail. Data were analyzed from April 15, 2019, to October 11, 2019. Tool accuracy and user experience and satisfaction. As of April 30, 2019, 4610 estimates (3569 [77.4%] via internet; 1041 [22.6%] via telephone) were produced using the cost estimator tool. Among 342 individuals who had an estimate and a matching explanation of benefits statement, 287 estimates (83.9%) were accurate. All 342 individuals with an estimate and an explanation of benefits statement were invited to participate in a user survey, and 125 individuals completed the survey (36.5% response rate). Survey respondents included 92 (73.6%) women, 72 (57.6%) non-Hispanic white participants , 91 participants (72.8%) with a college degree or higher, and 55 participants (44.0%) with an income of $100 000 per year or higher. Mean (SD) age was 46.8 (13.1) years. Ninety-nine participants (79.2%) found the tool easy to use, 109 participants (87.2%) would use it again, and 100 participants (80.0%) would recommend it to others. Seven participants (5.6%) reported contacting a clinician about the estimate, and 12 participants (9.6%) changed their decision based on the estimate. This quality improvement study is the first report of an online cost estimator in an integrated health care delivery network. The findings suggest that the tool, informed by real-time data feeds from third-party payers, was easy to use and provided accurate results. Increasing the number of searchable services and sharing best practices with other health care systems who share the same portal platform are the next steps for the tool.
Highlights
Health care has been slow to embrace price transparency
Seven participants (5.6%) reported contacting a clinician about the estimate, and 12 participants (9.6%) changed their decision based on the estimate. This quality improvement study is the first report of an online cost estimator in an integrated health care delivery network
Increasing the number of searchable services and sharing best practices with other health care systems who share the same portal platform are the steps for the tool
Summary
Health care has been slow to embrace price transparency. The Patient Protection and Affordable Care Act mandates price transparency, and a new Centers for Medicare & Medicaid Services rule requires hospitals to publish their fee schedule on their websites.[1] This rule has led to widespread comment that it fails to achieve the objective of genuine price transparency because of wide variation in patients’ yearly deductibles, coinsurance, and contracted rates with health insurers relative to list prices.[2]. Recent estimates indicate that 46% of individuals in the United States younger than 65 years are covered through high-deductible health plans.[3] Continued growth of these plans underlines the importance of effective tools to enable patients to compare prices and quality of services from different health care networks.
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