Highmark joins price transparency movement


As Highmark puts the final touches on its new cost estimator tool, which launches this spring, the insurer is contributing to a broader industry-wide movement to increase transparency of medical costs while highlighting quality providers.

Highmark's online "Care Cost Estimator" will let members obtain their estimated out-of-pocket costs for certain medical procedures, compare doctors and hospitals with national quality data, plus find information about doctors' medical training and board certifications, the insurer announced Tuesday.

"It's exciting because it really goes to the core costs," Steven Nelson, Highmark's senior vice president for health services, strategy, product and marketing, told the Pittsburgh Post-Gazette. "You will have 1,000 patients who are engaged in their care before they get care. That's moving the needle."

Nelson clarified, however, that Highmark isn't making prices clear and available to drive consumers to cheaper care, but instead to provide enough information so they can decide cost and quality for themselves. "People are led by their physician. The question is, are they also going to be led by their wallets?"

With this new tool, Highmark is helping further the transparency trend among insurance companies and policymakers. Massachusetts insurers Harvard Pilgrim, Blue Cross Blue Shield and Tufts Health Plan have all either launched or are working on cost estimator tools that provide quality data and pricing information, FierceHealthPayer previously reported. Aetna offers cost and quality information to its members as well.

This increase in transparency has been a long time coming for U.S. Rep. Michael Burgess (R-Texas), who has been trying for 10 years to pass legislation requiring insurers provide out-of-pocket costs to their members. The problem, he says, is that patients don't really understand the pricing inconsistency of medical procedures because insurers cover most of the costs, the Post-Gazette noted.

"As long as the insurer insulates the patient from the cost of the care, the sky's the limit. We have educated patients that more is better when it comes to testing, X-rays and that sort of thing," Burgess said. "You need to get patients actively involved in what their care actually costs."

To learn more:
- read the Pittsburgh Post-Gazette article
- here's the Highmark announcement

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