Resolution 14-S16. Advocating for Cost Transparency

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(Sponsor: Illinois Northern Chapter)

WHEREAS, the American College of Physicians has supported "the goal of price transparency for services and products provided by all healthcare stakeholders to patients/consumers."1; and

WHEREAS, ACP also recommends that the information be accessible and clearly presented. However, the Accountable Care Act and the emergence of Accountable Care Organizations (ACO) have redesigned health care delivery to focus on population health, and comply with the Institute of Medicine's Triple Aim: reduce the overall total cost of care, improve quality and improve the patient/consumer experience; and

WHEREAS, the ACO model steers patients/consumers to low cost, efficient service providers by contracting with these entities for lower negotiated fees. Narrowed provider networks may place a higher burden of copays, deductibles and overall out of pocket costs for patients/consumers if they seek services out of the tiered network of their benefit design. This marketplace phenomenon underscores the importance of transparent pricing for facility, ambulatory surgical and imaging facilities, and laboratory fees. Negotiated pricing by ACO or payer networks with healthcare providers incurs costs that may be specific to a benefit plan and payer; this information should be readily available to patients/consumers to minimize their cost burden; and

WHEREAS, the cost of healthcare increases annually at least 5%, albeit at a lesser percentage compared to the past several years; and

WHEREAS, patients carry a higher burden of healthcare costs due to insurance plans providing cheaper premiums that carry higher deductibles, some exchange plans requiring out-of-pocket deductibles greater than $5,000; and

WHEREAS, the Accountable Care Act and Accountable Care Organizations incent providers through shared financial risk, encouraging providers to steer patients to lower cost imaging facilities, contracted laboratory, ambulatory surgical and urgent care facilities; and

WHEREAS, the Institute of Medicine's triple aim encourages higher quality healthcare, for populations of patients, at lower cost; therefore be it

RESOLVED, that the Board of Regents advocates to ensure health insurance plans grant patients access to costs of diagnostic imaging, common laboratory tests, ancillary services (such as physical therapy, rehabilitation) and facility fees, as allowed by the benefits of the specific health plan, and that deductibles and copays for which patients are accountable are clearly elucidated at the time of scheduling.

1 ACP Position Paper on Healthcare Transparency-Focus on Price and Clinical Performance Information. 2010.