Price Transparency Tools Research Articles

Employer Strategies for Health Care Price Transparency.

This paper describes hospital, insurance, and pharmaceutical price transparency policies and applications in the United States and in selected countries around the world. Many of these policies apply to self-insured employers. So far, the experience in the United States and elsewhere is clear that federal and state price transparency regulations have had little impact on whether employees or dependents search for low-cost or high-quality providers or on the cost and quality of their health care. This is because of weak regulatory oversight, conflicting federal and state reporting requirements, and few economic incentives for providers and insurance companies to supply easily readable or analyzable price information. However, price transparency requirements are here to stay. This paper therefore offers several recommendations to maximize the utility of price transparency tools provided for employees and other insureds, by their employers, providers, commercial insurance carriers, or technology firms. From a policy perspective, coupling reporting requirements with clearer technological guidance and much stronger regulatory oversight would increase the utility of price transparency efforts. For individual employers, the impact of price transparency efforts may increase by coupling price transparency tools with health plan network and design strategies, behavioral economic nudges, and programs designed to improve health, well-being, and quality of care. Many program vendor partners, consultants, and actuarial, technology, and research firms can help make these efforts useful.

Factors Influencing Community Decisions in Choosing Community Health Centers for Promotive and Preventive Health Services: Literature Review

Introduction: Minister of Health Regulation Number 43 of 2019 stated that Community Health Centers (Puskesmas) were health service facilities that provided community health efforts (UKM) and individual health efforts (UKP) at the first level, prioritizing promotive and preventive efforts in their working areas. The reason for composing this article was crucial, as Community Health Centers, as both general health services and providers of promotive and preventive services, were expected to attract public interest.. Objective: Analyzed factors influencing community choices of health centers for promotive and preventive services. Method: A qualitative research study was conducted, employing a literature review via electronic databases, particularly utilizing Scopus journal sources. Keywords like "Primary health care," "consumer attraction," and "decision to visit the health center" guided the search, Inclusion criteria set for articles published in English, freely accessible, and between 2019 and 2023. Result: Based on the literature search process through electronic databases, 7 articles were obtained. The selected articles met the predetermined criteria. These articles were related to the use of price transparency tools, community satisfaction and dissatisfaction, the Health Extension Program, the crucial role of good healthcare services, as well as the influence of income and grants. Conclusion: Factors influencing the community's choice of Community Health Centers as a health service included offering lower service costs through insurance or BPJS Kesehatan, the presence of the Health Extension Program (HEP), patient satisfaction with services, gender factors, income, access to grants, and contact with health education.

Healthcare price transparency in North America and Europe.

Healthcare price transparency is an effort to inform patient decision-making, but also to decrease prices and their variation across healthcare systems for equivalent medical services. The initiative is meaningful only for medical services that are shoppable-such as imaging examinations-for which patients incur out-of-pocket costs. Therefore, several countries in which patients commonly share a portion of their healthcare costs have been implementing mandates to improve healthcare price transparency. However, the provisional implementation has many issues, especially in the United States, including provider non-compliance and limited accessibility of price transparency tools by the general public. Many of the existing tools are not user-friendly, are difficult to navigate, focus on charges and health plan negotiated rates rather than patients' out-of-pocket costs, and disclose prices on the service level instead of per episode of care. As such, the disclosed amounts are often not reliable. Many price transparency tools also lack valid and measurable quality metrics, which can result in a selection of high-cost care as a proxy for high-value care, as well as an increase in healthcare prices when providers want to imply they offer high-quality care. Nevertheless, the impact of the initiatives on patients' decision-making and healthcare costs remains unclear. While transparency initiatives are patient-centric, efforts should be made to increase patient engagement, provide accurate patient-specific out-of-pocket cost information, compare available treatment and provider alternatives, and couple price information with quality metrics to enable making fully informed decisions.

Implementing real-time prescription benefit tools: Early experiences from 5 academic medical centers

BackgroundMedication price transparency tools are increasingly available, but data on their use, and their potential effects on prescribing behavior, patient out of pocket (OOP) costs, and clinician workflow integration, is limited. ObjectiveTo describe the implementation experiences with real-time prescription benefit (RTPB) tools at 5 large academic medical centers and their early impact on prescription ordering. Designand Participants: In this cross-sectional study, we systematically collected information on the characteristics of RTPB tools through discussions with key stakeholders at each of the five organizations. Quantitative encounter data, prescriptions written, and RTPB alerts/estimates and prescription adjustment rates were obtained at each organization in the first three months after “go-live” of the RTPB system(s) between 2019 and 2020. Main measuresImplementation characteristics, prescription orders, cost estimate retrieval rates, and prescription adjustment rates. Key resultsDifferences were noted with respect to implementation characteristics related to RTPB tools. All of the organizations with the exception of one chose to display OOP cost estimates and suggested alternative prescriptions automatically. Differences were also noted with respect to a patient cost threshold for automatic display. In the first three months after “go-live,” RTPB estimate retrieval rates varied greatly across the five organizations, ranging from 8% to 60% of outpatient prescriptions. The prescription adjustment rate was lower, ranging from 0.1% to 4.9% of all prescriptions ordered. ConclusionsIn this study reporting on the early experiences with RTPB tools across five academic medical centers, we found variability in implementation characteristics and population coverage. In addition RTPB estimate retrieval rates were highly variable across the five organizations, while rates of prescription adjustment ranged from low to modest.

Incidence of Typical Neutrophil Count with Fy(a-b-) Status Among Hematology Referrals for Neutropenia at an Urban Safety-Net Hospital

Typical neutrophil count with Fy(a-b-) status, known variously as Duffy null phenotype or Benign Ethnic Neutropenia, causes asymptomatic neutropenia without clinical sequelae.[i][ii] Fy(a-b-) phenotype is correlated to homozygosity of a single nucleotide polymorphism in the promoter region of atypical chemokine receptor 1 (ACKR1; formerly known as DARC), a decoy chemokine receptor, and may protect against malaria infection.[iii][iv] This genotype is enriched in malaria-endemic regions.[v] 25% to 50% of people of African ancestry in the United States are thought to have Fy(a-b-) status and are often erroneously identified as having pathologically low neutrophil counts. We performed a retrospective chart review of new neutropenia referrals to Hematology Clinic at Boston Medical Center (BMC) to evaluate diagnostic patterns for typical neutrophil count with Fy(a-b-) status. Overall, 103 new referrals for evaluation of neutropenia were made to BMC Hematology Clinic from 1/2020 to 2/2022, of which 78 were included for further analysis. Demographic and laboratory data are summarized in the accompanying Table. Typical neutrophil count with Fy(a-b-) status was identified as the primary etiology for neutropenia in 64.1% (50 of 78 referrals), of which 41 (82%) identified as African American or Black or were born in an African or Caribbean country. Of patients suspected of having Duffy null phenotype, 66% (33 of 50 patients) underwent confirmatory blood bank testing, and 97% (32 of 33) of these patients were found to have Fy(a-b-) status. Average cost of laboratory visit was calculated for each new referral using the Outpatient Price Transparency Tool from BMC Billing Department, which is based on chargemaster prices for the hospital. Patients with typical neutrophil count with Fy(a-b-) status on average had lower, but not negligible, cost of workup ($363.82 vs $689.46; p<.005 by unpaired student's T test assuming unequal variance) and were statistically less likely to have a follow up appointment (p=0.039 by unpaired student's T test assuming unequal variance) compared to those without. Though this phenotype reflects normal variation of white cell count in non-White populations, it is a "...label that illustrates how common phenotypes seen in non-White individuals continue to be considered nonstandard in the medical community." Workup of referrals that have typical neutrophil count with Fy(a-b-) status is not currently recommended, unless they have a change in their baseline white cell count or new, atypical features concerning for a secondary etiology.[vi] In our study, asymptomatic referrals were the majority and represent an unnecessary cost burden on an overtaxed healthcare system. Fy(a,b) antigen testing provides a low-cost alternative to hematology referral for confirmation of Fy(a-b-) status for patients or providers who require reassurance. Expanded use of serological Fy(a,b) antigen testing by primary care providers for patients with ancestry from malaria-endemic regions and chronic, asymptomatic neutropenia could reduce cost of care and referrals to Hematology clinic. [i] Ortiz MV, Meier ER, Hsieh MM. Identification and Clinical Characterization of Children With Benign Ethnic Neutropenia. J Pediatr Hematol Oncol. 2016 Apr;38(3):e140-3. doi: 10.1097/MPH.0000000000000528. PMID: 26925714; PMCID: PMC5102334. [ii] Merz LE, Achebe M. When non-Whiteness becomes a condition. Blood. 2021 Jan 7;137(1):13-15. doi: 10.1182/blood.2020008600. PMID: 33181819. [iii] Reich D et al. Reduced neutrophil count in people of African descent is due to a regulatory variant in the Duffy antigen receptor for chemokines gene. PLoS Genet. 2009 Jan;5(1):e1000360. doi: 10.1371/journal.pgen.1000360. Epub 2009 Jan 30. PMID: 19180233; PMCID: PMC2628742. [iv] Miller LH, Mason SJ, Clyde DF, McGinniss MH. The resistance factor to Plasmodium vivax in blacks. The Duffy-blood-group genotype, FyFy. N Engl J Med. 1976 Aug 5;295(6):302-4. doi: 10.1056/NEJM197608052950602. PMID: 778616. [v] Haddy TB, Rana SR, Castro O. Benign ethnic neutropenia: what is a normal absolute neutrophil count? J Lab Clin Med. 1999 Jan;133(1):15-22. doi: 10.1053/lc.1999.v133.a94931. PMID: 10385477. [vi] Gibson C, Berliner N. How we evaluate and treat neutropenia in adults. Blood (2014) 124 (8): 1251-1258. https://doi.org/10.1182/blood-2014-02-482612 Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The impact of price transparency and competition on hospital costs: a research on all-payer claims databases

BackgroundPublic reporting has been considered effective in reducing health care costs by mitigating information asymmetry in the market as payers have incorporated publicly available information mandates into pay-for-performance programs and value-based purchasing. Therefore, hospitals have faced increasing pressures to provide price transparency. Despite the widespread promotion of healthcare transparency, the effectiveness of public reporting has not yet been sufficiently understood. This study analyzed the impact of transparency policy and competition on hospital costs by taking the state operations of all-payer claims databases (APCDs) as a case of interest.MethodsWe employed a fixed-effects regression, which allows the generation of hospital-specific effects, in accordance with the suggestion by the Hausman test. The study samples comprise nonprofit and for-profit general acute care hospitals in the United States for 2011–2017. The finalized dataset ranges from 3547 observations in 2011 to 3405 observations in 2015 after removing missing values.ResultsWe found that hospitals in the states with APCDs tend to bear higher average operating expenses than those without APCDs, which may indicate that states maintaining higher healthcare expenditures are more attentive to a price transparency initiative and tend to adopt APCDs. With regard to competition, the results showed that weak market competition is significantly associated with higher operating costs, supporting the traditional competition theory. However, the combined effect of APCDs and competition did not indicate a significant association with operating expenses. Further investigation showed a continued tendency for a weak intensity of competition to be linked to lower hospital operating costs in states without APCDs. For those located in non-APCD adopted states, market consolidation helped hospitals coordinate care more effectively, economize operating costs, and enjoy economies of scale due to their large size. Similar trends did not appear in APCD-adopted states except for in 2015.ConclusionsThis study observed limited evidence of the impact of APCDs and market competition. Our findings suggest that states need to make multifaceted efforts to contain hospital costs, not solely depending on the rollout of cost information or market competition. Market concentration may lead to coordinated care or cost economization in some cases. Still, the existing literature also demonstrates some potentially harmful impacts of increased concentration in the healthcare market, such as inefficient use of resources, unilateral market power, and deterrence of innovation. The introduction of a price transparency tool may require additional policy actions that take market competition into consideration.

Costs Versus Quality in Imaging Examination Decisions.

Emerging price transparency tools allow consumers to access individualized out-of-pocket cost (OOPC) estimates, but many lack quality metrics. The aim of this study was to evaluate how potential patients weigh imaging OOPC versus measures of quality when selecting an imaging center for a hypothetical health condition (back pain). Surveying 1,310 Amazon Mechanical Turk volunteers, the authors evaluated how potential patients weigh MRI OOPC ($50 vs $400 vs unknown cost at the time of the examination, with billed OOPC responsibility varying between $50 and $3,500) versus service quality surrogates using three different quality indicators (examination results accuracy, physician recommendation of an imaging center on the basis of familiarity, and facility online star ratings) in their decisions when selecting a radiology center for imaging of two hypothetical clinical conditions (mild and severe back pain), using ranking-based conjoint analyses. A total of 1,025 eligible respondents completed the survey. Respondents expressed higher preference for perceived quality over cost in hypothetical severe back pain scenarios, resulting in a relative importance of 65.8% (95% confidence interval [CI], 62.2%-69.4%) for improved imaging results accuracy from 87% to 96%, 63.9% (95% CI, 60.3%-67.5%) for provider recommendations of the facility, and 80.1% (95% CI, 74.2%-85.9%) for an increase in online review star ratings from 2.5 to 4.5 (out of 5) compared with an increased cost from $50 to $400. For mild back pain, there was no statistical difference in respondents' preference for perceived quality and cost. Incorporating quality metrics into price transparency tools is important. Further research is needed to identify metrics that are most comparable and easily obtainable across imaging centers that remain important to patients.

Effects of Public Price Transparency Tools on Shopping for Health Care

Effects of Public Price Transparency Tools on Shopping for Health Care

Abstract 8935: A Study of CMS-Mandated Online Tools for Comparing the Prices of Outpatient Cardiovascular Diagnostic Studies

Objectives: To assess the tools the US Centers for Medicare &amp; Medicaid Services (CMS) price transparency mandate provides to patients to compare prices of cardiovascular (CV) diagnostic studies in US hospitals. Background: In January 2019, CMS mandated that hospitals make prices of CV diagnostic and treatment services available to patients to enable cost comparison. These prices are published in price lists called hospital chargemasters. Methods: We searched hospital chargemasters for the top 20 hospitals listed on the 2020-21 US News Best Hospitals Honor Roll. We collected published price data for six common CV diagnostic studies. Endpoints included listed prices, the format and uniformity of price listings, and accompanying disclaimers or guides for use. Results: Of the 20 studied hospitals, 19 (95%) published a chargemaster on their website, of which 16 were in Microsoft Excel format (84%) and 3 included standardized CPT codes (16%). Disclaimers that prices may not reflect real billing were included with 17 (85%). From available hospital chargemasters (n=19), the following price data were collected. Conclusions: The hospital chargemasters available to compare pricing of CV diagnostic studies show wide variation in price and scope, differ by format, and include technical terms and initialisms. Most include disclaimers that prices may not reflect actual out-of-pocket or insurance billing. These findings suggest that these CMS-mandated price transparency tools may be inadequate for patients to estimate or compare prices for CV diagnostic studies.

Assessing utilization of a marketwide price transparency tool.

Most transparency tools are provided by individual insurers for enrollees shopping for services within their networks. This paper seeks to understand the impact of a marketwide price transparency tool with an embedded randomized experiment to offer provider-level charge information. In September 2017, FAIR Health released an independent, publicly accessible statewide consumer shopping tool, New York Healthcare Online Shopping Tool, or NYHOST, that displays individual provider charges (list prices) for common procedures in each of New York State's 3-digit geozips, as well as the estimated insurer-allowed amounts and educational resources. The rollout was accompanied by an extensive, multipronged marketing effort. It also incorporated a randomized experiment: The set of procedures with provider-level information varied across areas. We characterized the types of services that were most searched on the consumer shopping tool. Utilizing negative binomial models with procedure and area fixed effects, we report on market and procedural characteristics that influence price search. Consumers utilized the tool strategically, searching more in procedure markets with provider-specific price information availability, more frequent out-of-network utilization, higher charges, significant charge dispersion, and substantial provider competition. We also found that the majority of searches using the tool were for emergent services not usually classified as shoppable, suggesting that consumers may also have used the tool to compare searchable prices against those in bills for services already received. Our findings confirm aspects of price search theory that have been developed by studying other industries and may prove instructive for further study of price transparency tools.

Price Transparency and Compliance With Federal Regulation for Pediatric Tonsillectomy.

To improve hospital price transparency, the Centers for Medicare & Medicaid Services (CMS) requires, as of January 2021, that all hospitals reveal charges for specific items and services. This analysis investigates whether otolaryngology residency-affiliated hospitals have complied with this new regulation, and it evaluates the variability in hospital-reported charges for pediatric tonsillectomy. Cross-sectional analysis. Subset of hospitals affiliated with otolaryngology residency programs. Hospital websites were searched to determine compliance rates with CMS guidelines by posting a price transparency tool and specific charges for Current Procedural Terminology code 42820 (tonsillectomy and adenoidectomy, <12 years old). Various charges were collected: gross charge, discounted cash price, deidentified minimum and maximum negotiated charges, hospital fees, and physician fees. Overall 104 unique hospitals were analyzed: 81 (78%) provided pricing data, but only 28 (27%) complied with CMS guidelines. The median reported total gross charge was $13,239 (range, $600-$41,957); deidentified minimum negotiated charge, $9222 (range, $337-$25,164); and deidentified maximum negotiated charge, $17,355 (range, $1002-$54,987). Hospital fees (median, $11,900; range, $2304-$38,831) were consistently higher than physician fees (median, $1827; range, $420-$5063). All estimates included a disclaimer stating that values likely underrepresent true prices. Hospital compliance with the new regulation remains low, which limits efforts toward improved price transparency. There is wide variability in reported charges for pediatric tonsillectomy and adenoidectomy.

Price Transparency in Radiology: Challenges and Opportunities to Improve.

Increasing health care consumerism has been proposed as a solution for rising U.S. health care costs. Although price transparency initiatives aim to inform patients about outof-pocket costs (OOPCs), challenges remain regarding price transparency tools, including limited accuracy of estimates, accounting for multiple payers for the same service, the need for quality measures, optimal OOPC delivery, and psychosocial consequences of OOPC information. As radiology practices consider implementing price transparency initiatives, improvements should address enhancing patients' experience with OOPC communication.

Patterns of Use of a Price Transparency Tool for Childbirth Among Pregnant Individuals With Commercial Insurance

When introduced a decade ago, patient-facing price transparency tools had low use rates and were largely not associated with changes in spending. Little is known about how such tools are used by pregnant individuals in anticipation of childbirth, a shoppable service with increasing out-of-pocket spending. To measure changes over time in the patterns and characteristics of use of a price transparency tool by pregnant individuals, and to identify the association between price transparency tool use, coinsurance, and childbirth spending. This descriptive cross-sectional study of 2 cohorts used data from a US commercial health insurance company that launched a web-based price transparency tool in 2010. Data on all price transparency tool queries for 2 periods (January 1, 2011, to December 31, 2012, and January 1, 2015, to December 31, 2016) were obtained. The sample included enrollees aged 19 to 45 years who had a delivery episode during 2 periods (November 1, 2011, to December 31, 2012, or November 1, 2015, to December 31, 2016) and were continuously enrolled for the 10 months prior to delivery (N = 253 606). Access to a web-based price transparency tool that provided individualized out-of-pocket price estimates for vaginal and cesarean deliveries. The primary outcomes were searches on the price transparency tool by delivery mode (vaginal or cesarean), timing (first, second, or third trimester), and individual characteristics (age at childbirth, rurality, pregnancy risk status, coinsurance exposure, area educational attainment, and area median household income). Another outcome was the association of out-of-pocket childbirth spending with price transparency tool use. The sample included 253 606 pregnant individuals, of whom 131 224 (51.7%) were in the 2011 to 2012 cohort and 122 382 (48.3%) were in the 2015 to 2016 cohort. In the 2015 to 2016 cohort, the mean (SD) age was 31 years (5.2 years) and most individuals had coinsurance for delivery (94 251 [77.0%]). Price searching increased from 5.9% in the 2011 to 2012 cohort to 13.0% in the 2015 to 2016 cohort. In the 2015 to 2016 cohort, 43.9% of searchers' first price query was in their first trimester. The adjusted probability of searching was lower for individuals with a high-risk pregnancy due to a previous cesarean delivery (11.5%; 95% CI, 11.0%-12.1%) vs individuals with low-risk pregnancy (13.4%; 95% CI, 12.9%-14.0%). Use increased monotonically with coinsurance, from 9.2% (95% CI, 8.7%-9.8%) among individuals with no coinsurance to 15.0% (95% CI, 14.4%-15.5%) among individuals with 11% or higher coinsurance. After adjusting for covariates, searching was positively associated with out-of-pocket delivery episode spending. Among patients with 11% coinsurance or higher, early and late searchers spent more out of pocket ($59.57 [95% CI, $33.44-$85.96] and $73.33 [95% CI, $32.04-$115.29], respectively), compared with never searchers. The results of this cross-sectional study indicate that the proportion of pregnant individuals who sought price information before childbirth more than doubled within the first 6 years of availability of a price transparency tool. These findings suggest that price information may help individuals anticipate their out-of-pocket childbirth costs.

Congress ends surprise billing: implications for payers, providers, and patients.

Compromise over ending surprise billing had consistently hit a deadlock as providers, payers, and patient groups found themselves at odds over mechanisms to resolve payment. The COVID-19 pandemic, however, accelerated legislative action on health care proposals, leading to the last-minute passage of the No Surprises Act at the end of 2020. The law marks a rare bipartisan success that promises to secure patient protections while also adding price transparency tools. Importantly, it creates an independent dispute resolution process that balances the demands of payers and providers in negotiating surprise billing. While the cost implications of this process will not be known until after implementation in 2022, it creates a template for states to emulate. Furthermore, it will reorient the relationships among payers and provider groups that have historically relied on out-of-network billing. This new competitive reality is an important step for consumer financial protection in health care.

Clinical Faceoff: How Will Recent Price Transparency Policies Impact Orthopaedic Surgery and its Patients?

Clinical Faceoff: How Will Recent Price Transparency Policies Impact Orthopaedic Surgery and its Patients?

Online Advertising Increased New Hampshire Residents' Use Of Provider Price Tool But Not Use Of Lower-Price Providers.

Insurers and policy makers have created health care price transparency websites to facilitate price shopping and reduce spending. However, price transparency tools to date have been plagued by low use. It is unclear whether this low use reflects a lack of interest or a lack of awareness. We launched a large online advertising campaign to increase consumers' awareness about insurer-specific negotiated price information available on New Hampshire's public price transparency website. Our campaign led to a more than 600percent increase in visits to the website. However, in our analysis of health plan claims, this increased use of the website did not translate to increased use of lower-price providers. Our findings imply that the limited success to date of price transparency tools in reducing health care spending is driven by structural factors that limit consumers' ability to use health care price information as opposed to only a lack of awareness about price transparency tools.

The Impact of Hospital Price and Quality Transparency Tools on Healthcare Spending: A Systematic Review

The Impact of Hospital Price and Quality Transparency Tools on Healthcare Spending: A Systematic Review

How to Increase Transparency and Promote Value in Healthcare: Information plus Incentives

The cost of healthcare in the United States is a major concern, and the prices of goods and services are a key contributing factor to excessive healthcare spending. However, patients in the United States rarely know what services cost beforehand, preventing them from making informed decisions about the value of the care they receive. Although price transparency tools are widely available, barriers such as a lack of awareness and the current structure of health plan benefits limit their use and effectiveness. Price transparency could have a large impact on the healthcare marketplace and lead to greater competition, increased value, and more efficient allocation of resources, but only if designing a robust incentive structure for consumers is a primary concern. In addition to reforming the current insurance-based system, policymakers should pursue “forward-looking” policies that disrupt the status quo by allowing consumers greater ownership of their healthcare resources and facilitating more direct transactions between consumer and provider.

Price Transparency in Radiology—A Model for the Future

Medicine is the only business transaction in which consumers make important purchase decisions without knowing how much they have to pay. Lack of price transparency in health care imposes financial burden and anxiety among patients as the cost of health care has been shifting from employers to patients through high-deductible health plans (HDHPs). Health economists and policymakers anticipated that HDHPs with price transparency would be a catalyst for patients to “shop” for low-price providers, thus reducing overall health care spending. For patients to shop health care services, price transparency is a requisite. The Department of Health and Human Services mandate of publicly disclosing the hospital chargemaster and state legislatures demanding greater health care price transparency are just two examples of external forces challenging the long history of price opacity in health care. Imaging, pharmacy, laboratory tests, and ambulatory surgeries are considered potentially shoppable health care services. This article examines the intended motivation of price transparency, the limitations of current price transparency tools, and what impact price transparency may have on radiology. We share our experience in developing and implementing University of Utah’s online interactive price transparency tool to estimate patients’ out-of-pocket expenses.

Assessment of Accuracy and Usability of a Fee Estimator for Ambulatory Care in an Integrated Health Care Delivery Network

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.