Price Transparency

With only weeks left in the Massachusetts legislative calendar, there are once again hundreds of proposed bills left for the legislature to deal with.  This means lots of backroom talks and deals will be required for the legislature to complete its work...

A new online tool from Pioneer Institute shows a gradual increase in non-commercial (public payer) revenue at Massachusetts hospitals and also reveals a strong relationship between the hospitals with the highest commercial revenue and those with the highest relative prices.

A 2019 federal law requires hospitals to make prices for 300 shoppable services available online in a “consumer-friendly format,” but a Pioneer Institute survey of 19 hospitals finds that information on discounted cash prices—the price most likely to be charged to consumers paying out of pocket—was unavailable at seven of those hospitals.

In June 2019, Pioneer Institute, with support from Blue Cross Blue Shield of Massachusetts and the Massachusetts Association of Health Plans, contracted with noted pollster David Paleologos, head of DAPA Research at Suffolk University’s Research Bureau, to conduct a valid and reliable survey of Massachusetts consumers with employer sponsored health insurance. The goals of the survey were to determine consumers’ awareness, attitudes, views, usage, and knowledge of healthcare prices. This white paper presents analysis of the results.

This report reveals that consumers in just one Massachusetts county could have saved nearly $22 million in a single year and $116.6 million adjusted for inflation over four years if they switched from using the most expensive providers for 16 shoppable healthcare services to those whose prices were closer to average.

This report examines why the Institute for Clinical and Economic Review (ICER) and the Quality Adjusted Life Years (QALY) approach to value assessment is particularly ill-suited to assess the cost-effectiveness of orphan and rare disease treatments, which represent a rapidly growing sector of the biopharmaceutical marketplace.

New study finds there is little correlation between a patient’s out-of-pocket cost and either the amount insurers pay or the overall price of a procedure at 14 representative Massachusetts hospitals.

This report finds that most new drug pricing transparency laws do not lower consumer out-of-pocket costs, and that expensive and onerous compliance rules would likely put upward pressure on prices. The report reviews recent New England legislative attempts to reduce costs by requiring the disclosure of wholesale drug prices and other information about industry pricing practices.

Data from the Massachusetts Center for Health Information and Analysis (CHIA) show wide variations in the prices agreed to between individual insurers and providers, the portion paid by insurers and the amount that is consumers’ responsibility to pay.

This study finds some significant improvements in the online cost estimator tools created by Massachusetts’ three largest health insurers, but there is much still to be done for the carriers to maximize the opportunity price transparency represents.