Report: California Receives ‘F’ for Health Care Pricing Transparency
California received a failing grade for its transparency of health care pricing, according to a report by the Catalyst for Payment Reform and the Health Care Incentives Improvement Institute, KQED's "State of Health" reports (Aliferis, "State of Health," KQED, 3/25).
Details of Report
For the report card, researchers examined:
- Whether states had health care pricing transparency laws; and
- How well states implemented such laws.
The report also factored in state health care pricing websites created through transparency laws, including the sites':
- Ease of use;
- Scope; and
However, states did not receive credit for websites run by local organizations that are not authorized by law.
In the latest report card:
- No states received an "A" grade in health care pricing transparency;
- Maine and Massachusetts received a "B" grade;
- Colorado, Vermont and Virginia received a "C" grade; and
- 45 states, including California, received an "F" grade.
Last year, two states -- Massachusetts and New Hampshire -- earned an "A" grade for their price transparency efforts. However, that was before the groups began grading states on their implementation of health care transparency laws (Robeznieks, Modern Healthcare, 3/25).
The report noted that California's Office of Statewide Planning and Development collects health care pricing data. However, it said that the data are based on how much individuals are charged rather than the amount insurers pay.
According to "State of Health," that pricing data is "virtually meaningless to consumers" because there typically is a discount off the "charge" price.
CPR said California should implement a statewide "all payer claims database" of prices from:
- Dental and prescription drug plans;
- Insurance companies;
- Medi-Cal; and
Medi-Cal is California's Medicaid program.
CPR said such a database would be a "superior source of price information for consumers because [it would contain] data on what was actually paid for all services and procedures from a broad group of payers."
Maribeth Shannon, with the California HealthCare Foundation, called the grading "a little harsh."
CHCF publishes California Healthline.
Shannon noted that "California does not have legislation requiring health plans submit (actual price paid) data anywhere, so it's impossible to build a website."
However, Shannon said consumers should be given more tools to calculate the costs of health services. She said, "There's a clear direction to put more financial responsibility on individual patients" under the ACA, adding, "[I]f you're giving them that responsibility, you really need to give them tools to make those decisions" ("State of Health," KQED, 3/25).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.