The health care industry was rocked last year by the CMS release of chargemaster prices for various common procedures, which for the first time showed consumers the wild pricing disparities that have been common for decades. The release stung particularly because it had very little to do with how much money providers make. FAIR Health, a national, independent not-for-profit, maintains a database of 16 billion billed medical and dental claims—a much better representation of actual cost—and is making it available to consumers. Organization president Robin Gelburd will discuss how both consumers and other parties can use that data to estimate and manage health care costs during a HIMSS14 presentation, “Empowering Consumers with Access to Healthcare Cost Information,” at noon on Thursday, Feb. 27.

“In the past, consumers were bit players in their own play, because the [health care] transaction occurred at the provider and plan level, but now the ground is shifting in a way that makes them center stage in their own care,” Gelburd says, citing changing payment models, public and private insurance exchanges, and cost sharing for consumers. “They have to be more proactive shoppers.”

FAIR Health was established in New York with money from a state settlement with insurance companies over excessive out-of-network charges, and has a mandate to provide health care cost data in a manner that’s easily comprehensible to consumers as well as useful for health plans and researchers. Its database covers claims for 129 million patients across the country (including Puerto Rico), from 2002 to the present.   

Gelburd’s presentation will demonstrate how and why cost transparency tools can be incorporated into a consumer-facing website, whether it’s an EHR, a health plan member portal, or a public or private exchange application. She expects the greatest interest from consultants, bill review companies, and health plans, though she says the information will also be useful anyone from a health system that’s considering becoming an insurer.

Transparency doesn’t always create clarity for consumers who don’t understand the details of how care is priced, Gelburd says. Polls indicate that many adults can’t answer basic questions about premiums, co-pays, and co-insurance. “We’re giving them to the keys to a new car,” she says. “It’s our responsibility to give them driver’s ed before we allow them on the road.”

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