Increasing Hospital Price and Quality Transparency

The Challenge

FLORIDA IS THE THIRD HIGHEST PRICE STATE FOR HEALTH CARE AS PER RAND HOSPITAL PRICE TRANSPARENCY STUDY 4.0

Large price discrepancies continue to exist between what private health plans/self-funded plans pay for hospital services and what Medicare pays as reported in the Prices Paid to Hospitals by Private Health Plans: Findings from Round 4 of an Employer-Led Transparency Initiative from the RAND Corporation. The Florida Alliance team worked diligently to increase the number of employers able to submit their claims data to RAND 4.0, resulting in a five-fold increase over what data our employer members had successfully included in RAND 3.0.

Click here to access the report and data https://www.rand.org/health-care/projects/price-transparency/hospital-pricing/round4.html

The recently released updated RAND study examined 2018 – 2020 claims data from employers, private insurers, and 11 state all-payer claims databases (APCDs) for more than 4,000 hospitals and 4,000 additional ambulatory surgery centers across 49 states and the District of Columbia. Unfortunately, Florida’s APCD was not included in the study due to data use agreement limitations.

In Florida, the prices paid to hospitals for privately insured patients by employers averaged 309% of what Medicare pays, more than double of the commercial breakeven point calculated by the National Academy of State Health Policy (NASHP) at 148% of Medicare for the state. As a result, Florida ranks as the third most expensive state for employers purchasing hospital services. 

NASHP’s new Hospital Cost Tool dashboard provides insights into how much hospitals spend on patient care services, and how such costs relate to the hospital charges (list prices) and actual prices paid by health plans. Click here to access the dashboard  https://d3g6lgu1zfs2l4.cloudfront.net/ The Florida Alliance team is using the data from RAND 4.0, the NASHP Hospital Cost Tool, and the new Sage Transparency hospital value dashboard, which includes RAND and NASHP pricing data as well as quality metrics, to educate our members and other key stakeholders in Florida. Click here for Sage Transparency https://dashboard.sagetransparency.com/

 

Our Solution

The RAND study, the NASHP Hospital Cost Tool, and Sage Transparency are the tools needed by the Florida Alliance and our employer members to prepare for important conversations with hospitals and health plans.

  • The goal is to enable employers to be better informed consumers when shopping for health plans and provider networks.
  • Insights from these transparency initiatives allow the Florida Alliance for Healthcare Value staff and employer members to assess whether their negotiated prices are reasonable and how effectively their insurance carriers negotiated with providers.

Our focus is to identify what a fair price should be for Florida’s employers to pay for health care. For more information on our work on identifying that fair price, please contact Karen van Caulil at karen@flhealthvalue.org

“Employers say the proof of how much more they pay underscores the need for change.”New York Times, September 2020

Recruitment and Contact

Recruitment for the RAND 5.0 Hospital Price Transparency Study is underway. If you would like to participate or receive more information, please contact Ashley Tait-Dinger, MBA. Participation in this project is open to all self-funded employers. Being a member of the Florida Alliance is not required.