Transparency Action Plan 2016 Kick-off Meeting Overview
Iowa hospitals are leading in transparency efforts to provide patients with essential price and quality information for making informed healthcare decisions. The increase in consumer engagement due to rising deductibles and out-of-pocket costs is driving the need for transparent healthcare pricing. However, the variability in national hospital rating systems and the complexity of methodologies may lead to confusion among consumers. Emerging companies are taking advantage of this disorganization, while examples like Portland's retail healthcare market showcase the opportunities for consumerism in healthcare.
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Presentation Transcript
IHA Transparency Action Plan: 2016 Kick-off Meeting 1/20/16
How We Got Here: Long history of Iowa hospitals leading in transparency Patients are assuming greater financial responsibility for their health care need and Need information to make informed health care decisions. Price is not the only information needed to make these decisions, but it is an essential component. Hospitals are making a concerted effort to provide the price information that patients and other care purchasers require. And information on quality, patient safety and patient satisfaction is also a key resource
Why Now? RWJF Public Survey Findings 56% 40% 67% 74% Of patients tried to get information on out-of-pocket costs before getting care. Sought price information before a medical test 38% before seeing specialist 37% before visit to primary care doctor 25% before a hospital stay With deductibles between $500-$3,000 are more likely to seek price information Of those with deductibles exceeding $3,000.
Why Now? As deductibles and out-of-pocket expenses increase, consumers become more engaged in their purchasing decisions. Source: Bryce Bach, Oliver Wyman: The Rise of Consumerism in Health Care, 2015
Transparency: Four national hospital rating systems for consumers vary widely in their results: U.S. News & World Report s Best Hospitals, HealthGrade sAmerica s 100 Best Hospitals, Leapfrog s Hospital Safety Score, Consumer Reports Health Safety Score No hospital rated as high performer by all four Only 10% of 844 hospitals rated high performer by one rating system were rated as a high performer by any other rating system
Multiple Studies/Reports Confirm: Complexity and black-box methodology is likely to cause confusion
Emerging Companies are profiting off of this disorganization
Retail Market and Consumerism Example: Portland, OR 28 neighborhood clinics and advanced care studios delivering: Urgent care Primary care Advanced self-care Pediatrics Mental health Emergency services Specialty care Outpatient surgery.
Zoom+ Mobile online scheduler Same-day access to over 500 no-wait appointments
Zoom+ Publishing transparent prices on its website Example: Service Illness Visits Injury Visits Pediatrics Chronic Care Ear-Nose-Throat Mental Health Orthopedics Podiatry Cardiology Gastroenterology Natural Medicine Physical Therapy Video Visits X-RAY Ultrasound CT Self- Pay $145 $145 $250 $200 $140 $200 $200 $200 $200 $200 $145 $195 $35 $65 $199 $299 Other Insurance Co-Pay or Deductible Co-Pay or Deductible Co-Pay or Deductible Co-Pay or Deductible Co-Pay or Deductible Co-Pay or Deductible Co-Pay or Deductible Co-Pay or Deductible Co-Pay or Deductible Co-Pay or Deductible Co-Pay or Deductible Co-Pay or Deductible Covered by select insurance plans Co-Pay or Deductible Co-Pay or Deductible Co-Pay or Deductible
What does this mean for hospitals? Consumer demand for: Justification Education/Understanding Competitiveness in pricing is growing rapidly. Can you compete with a $299 CT scan? Do your clinics offer $35 video visits?
Retail Market and Consumerism This is coming to a market near you Source: Oliver Wyman; Rise of Consumerism in Health Care; Bryce Bach
IHA Responds Board Workgroup on Transparency February 2015 IHA Board creates workgroup and charge All IHA Districts and health systems covered Workgroup Members Ted Townsend, UnityPoint Health-St. Luke s, Cedar Rapids Steve Baumert, Nebraska Methodist Health System-Jennie Edmundson Hospital, CB Jack Dusenbery, Wheaton Franciscan Healthcare-Iowa, Waterloo Sean Williams, Mercy Medical Center-Clinton Marie Knedler, CHI Health Mercy Council Bluffs Marty Guthmiller, Orange City Area Health System, Orange City Scott Curtis, Kossuth Regional Health Center, Algona Brian Dieter, Mary Greeley Medical Center, Ames Fran Tramp, Burgess Health Center, Onawa Dave Muhs, CFO, Henry County Health System, Mt. Pleasant Tim Horrigan, MD, CMO, UnityPoint Health-Allen Hospital, Waterloo Sandra Christensen, CFO, Mercy Health Network, Des Moines Renee Rasmussen, VP of Revenue Cycle, UnityPoint Health System, West Des Moines Steve Alger, CFO, Lakes Regional Healthcare, Spirit Lake Michael Henley, CFO, University of Iowa Healthcare, Iowa City
IHA Board Workgroup on Transparency Major challenge: Transparency is a very broad (and complicated) area: Price Fixed price Cost vs. charges Quality/patient safety Patient friendly billing Chargemaster Insurance or employer sponsored out-of-pocket costs In fact, multiple parties have a role in transparency And a lot of conflicting public sources noise out there
IHA Board Workgroup on Transparency Workgroup objectives: Focus on transparency in the areas of price, quality and patient friendly billing Develop an action plan: Identify strategies, opportunities and recommendations for Iowa hospitals to lead in transparency Identify action for IHA (and IHC) to enhance resources and lead in Iowa hospitals data transparency Defined an IHA action plan for presentation to the IHA Board and leadership at the IHA Board Retreat in August on Iowa hospital leadership in transparency
Process and Timeline Workgroup held meetings this summer Developed and presented Action Plan at the IHA Board Retreat in August. Presented to IHA District meetings in September to gather additional input. IHA Board approved the action plan and transparency principles in October. IHA distributed the IHA Transparency Action Plan and Principles to Iowa Hospital CEOs in October. Implementation begins in 2016 and beyond.
Action Plan Summarizes steps for IHA and Iowa Hospitals in the areas of: Hospital Chargemaster Transparency Patient Friendly Billing Price/Quality Transparency Provides specifics on steps for hospitals to take and steps for IHA.
Hospital Chargemaster: IHA: Provide education to members on California Hospital Association Modern Pricing and provide CHA Guide and other resources to assist members. Facilitate education programming to highlight hospital best practices in price transparency, bundling and consumer education/outreach. Identify voluntary consultative resources to assist members in chargemaster review and cost analysis.
Patient Friendly Billing: IHA: Develop a member-focused transparency section on the IHA website. Partner with HFMA and distribute HFMA Patient Friendly Billing resources including the Consumer Guide to members. Provide education and training programs for members. Identify resources for hospitals to voluntarily utilize to provide patients with out-of-pocket estimates.
Price/Quality: IHA: Enhance the IHA Iowa Hospital Facts (www.iowahospitalfacts.com) website. Develop and implement a new website similar to the Indiana My Care Insights website that provides both hospital comparative charge and quality data (replacing Iowa Hospital Charges Compare website). Work with IHC to enhance its Iowa Report with hospital quality and patient safety data. Develop major enhancement to IHA IPOP to collect and release ANSI835 remittance (payment) discharge data to Iowa hospitals. Provide transparency resources such as AHA developed Transparency Toolkit through IHA website. Provide education programming through an IHA sponsored Transparency Conference. Transparency education track at IHA Annual Meeting. Transparency will be a topic in the IHA Business Forum webinar series in 2016.
Transparency Principles for Adoption 1. Iowa hospitals support price and quality transparency and strive to communicate information that is useful to patients, families and other health care purchasers. 2. Iowa hospitals should lead in transparency in their communities by: 1. Providing patients with information that encourages engagement in their health and health care, 2. Empowering patients and other health care purchasers to make value (price and quality) comparisons prior to receiving or purchasing health care services, and 3. Enabling open and clear lines of communications that facilitate conversations with patients and families at the point of care delivery. Iowa hospitals should lead in transparency of billing practices by: 1. Implementing strategies to communicate information to patients and other health care purchasers; and 2. Assisting patients in better understanding the total value of their care, including estimated out-of-pocket expenses. 3.
Principle/Action Plan Adoption Process IHA Board approved 10/6/15, IHA seeking Iowa hospital governing boards adoption by 1/31/16
2016 Patient Financial Communication Best Practices: From Theory to Implementation Webinar IHA webinar scheduled for Wednesday, February 17 from 1:30-2:30 p.m. Sandra J. Wolfskill, Director of Health Care Finance Policy and Revenue Cycle with HFMA s national office will introduce the topic of best practices in patient financial communication and describe the development of the best practice guidelines which recommend appropriate patient financial conversations in the registration area as well as the emergency department. The program will provide information on the rationale behind the best practices and the areas included in them as well as a checklist tool that helps providers identify gaps in current processes. Additionally, Wolfskill will detail how hospitals can access the patient financial communication training program and apply for adopter recognition through HFMA.
IHA Transparency Conference Wednesday, April 27 at Hilton Garden Inn, Johnston, IA Opening keynote: Surviving and Thriving in the New Health Care Consumerism Environment, Bryce Bach, Oliver Wyman, Chicago, IL Three educational tracks: Chargemaster Patient Friendly Billing Price and Quality Transparency Closing keynote: To be announced
