11 hours ago Castle Connolly Top Doctors – Castle Connolly Medical Ltd. Clear Health Costs – Clear Health Costs. Clinician Report Card – National Committee for Quality Assurance. Care Compare – Physicians – The Centers for Medicare & Medicaid Services. DocInfo Physician Profile Report – Federation of State Medical Boards. >> Go To The Portal
On January 1, 2022, parts of the new federal transparency rules, Transparency in Coverage and the No Surprises Act, will go into effect, mandating employer plan sponsors and health plans to provide crucial pricing information that could empower consumers to make better-informed decisions about their care.
Providing human support—clinical and benefits experts who can help individuals navigate not just cost of care transparency, but their entire personal health journey—will be imperative to reach the total population, especially those with low health literacy, poor technology, and other special needs.
Ultimately, the new transparency regulations are a great opportunity for employers to re-engage their population, educate them on the importance of evaluating their care options, and vastly improve their employees’ overall health navigation experience; however, in order for that to happen, employers must go beyond compliance.
CPR's mission is to meet the nation's growing and increasingly diverse health care needs by ensuring patients have direct access to the full scope of services offered by their chosen health care providers.
For the past four years, Altarum’s Center for Payment Innovation (formerly the Health Care Incentives Improvement Institute) and Catalyst for Payment Reform (CPR) have published separate state report cards on health care price transparency and physician quality transparency. The reports provided policymakers, consumer advocates, and other health care leaders comprehensive information on how readily consumers could find health care price and quality information in every state across the country. Further, they started a national dialogue on transparency and, in some cases, prompted lawmakers to introduce legislation. The reports have served as invaluable resources to patients, advocates, payers, and clinicians who value price and quality transparency and have used the reports not only to understand where there are transparency deficits across the country, but also to identify the high performing states whose transparency models can be emulated or adapted.
One of the most compelling reasons to provide quality data on individual physicians is to equip consumers to choose physicians in an informed manner. However, if there are too few physicians included in the quality ratings to ensure the ratings are reliable, transparency tools can’t deliver that value.
Health outcome measures—those that assess the impact of health care on health —are considered the most direct appraisals of health care quality.2 These can be dicult to measure, and can be paired with process measures—assessments of the care providers delivered—and with patients’ own surveys of their experiences with care to create a more complete picture of quality. Quality transparency tools should incorporate various outcomes measures.
To procure health care price data, states can either compel providers and/or health plans to report prices, or mandate an all payer claims database (APCD). APCDs collect data from multiple sources, including private health insurers, Medicaid, children’s health insurance, state employee health benefit programs, prescription drug plans, dental insurers, self-insured employer plans, and Medicare (if available to a state). APCDs are widely considered to be superior data sources because they include actual paid amounts—not charged amounts—which often are significantly lower due to contracted or negotiated rates between payers and providers. When there is no APCD, providers typically only turn over data on charged amounts to states or consumers, making the price information significantly less useful for comparisons.