Auditor Diana DiZoglio this month released an audit of the Center for Health Information and Analysis suggesting site improvements. CHIA’s response revealed a blunt admission: CompareCare isn’t being used because it isn’t particularly useful.
As DiZoglio wrote, “CHIA officials informed us that, on any given day, the CompareCare website receives low web traffic. Additionally, CHIA officials told us that they did not prioritize promoting the CompareCare website because health care consumers can get more accurate health care cost estimates from commercial insurance companies.”
CHIA’s executive director Lauren Peters told the editorial board there was moderate interest when the site first launched, but the number of people visiting the site each day now is, on average, in the single digits.
Transparency, in a complex field like health care, is important. Researchers, policy makers, and consumers should be able to understand health care pricing. CHIA has, as instructed by the Legislature, produced an easy-to-use site with health care pricing information.
But, as has become clear since the site was created, transparency won’t sway consumer behavior. People don’t shop for health care the way they shop for airline tickets, so creating an Expedia for health care doesn’t work.
The state shouldn’t eliminate CompareCare. But policy makers should be rethinking who could benefit from it, what purpose it serves, and what tweaks would make it more relevant. CHIA is having those conversations, Peters said, with officials looking at what health care decisions an improved website could help with, like selecting an insurance plan or plan type or finding an in-network primary care doctor. DiZoglio suggested CompareCare could do a better job including hospital quality metrics, like rates of health care-associated infections. That’s worth considering, especially given recently passed legislation that requires the development of a standard set of health care quality metrics.
Today a consumer can enter their insurance company and search for a procedure on CompareCare and the site will show the estimated cost at multiple hospitals as of 2022. However, the tool can’t tell consumers how much they will pay in 2025. As the site notes prominently, a patient who wants to know their personal cost should use their insurer’s price comparison tool, which considers their insurance plan, copays, deductibles, and network.
Because of how the health care market operates, there are few circumstances when the price of an MRI — as opposed to the amount someone’s insurance company will bill them for that MRI — actually matters to consumers.
Someone with a high deductible health plan may be more price sensitive. But as Ateev Mehrotra, chair of the Department of Health Services, Policy and Practice at the Brown University School of Public Health, points out, someone probably won’t bother price shopping for an inexpensive blood test, while a surgery is probably expensive enough that a patient will meet their deductible. Additionally, Mehrotra said, it’s hard to accurately compare prices between hospitals. Someone comparing knee surgery prices won’t know if one hospital adds a facility fee or another charges more for a preoperative visit. If a doctor affiliated with a particular health system recommends a patient get surgery at an affiliated hospital, the patient will probably be reluctant to override their physician. And health care systems make it hard for patients to get referred out.
State Senator Cindy Friedman, who cochairs the Legislature’s Joint Committee on Health Care Financing, said having a website where consumers can compare health care prices made sense in theory, but the complexity of the health care system makes it impossible in practice. “What we’ve learned is the system doesn’t allow for that information to be easily digested and put on a website,” Friedman said.
Additionally, as Peters noted, CompareCare focuses on elective outpatient procedures because they are considered “shoppable” services. “But we aren’t seeing a lot of people shopping at this time for elective procedures; they’re going where their doctor tells them to go or where they’re covered in network,” Peters said.
Pricing data can be useful. A company considering two insurance companies could determine which is likely to be cheaper for the employer by knowing how much each insurer pays local providers. That information could help employers contain their health care costs. Data can inform policy discussions about addressing unwarranted price variation. Providers can see how much competitors are charging. And yes, consumers can learn which facilities charge more.
And there are ways to incentivize consumer behavior based on price. Insurers can charge lower copays for lower-priced providers or offer limited network plans or cash rewards programs. But these are all policy decisions that go beyond transparency.
This issue is timely because President-elect Donald Trump has, since his first term, prioritized transparency in health care pricing. Since a 2019 federal price transparency law required hospitals to post pricing data online, a large trove of data has become available to researchers, despite issues with hospitals not complying or posting data in hard to use formats.
Barbara Anthony, Pioneer Institute’s senior fellow in health care, has pushed for price transparency since she was Massachusetts undersecretary of the Office of Consumer Affairs and Business Regulation. But she said she’s taking a step back, because much of the data is public, and the real challenge is figuring out how to use it. “We need to look beyond what we’re doing with making prices transparent to is it having an effect and if not, what more do we have to do to make the marketplace a place where transparency can mean something to consumers?” Anthony said.
The experience of CompareCare — and similar websites nationwide — suggests transparency is a necessary first step. The next step has to be figuring out how to use the information to lower spending.
Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.
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