BackgroundBest Practices

Background

The New York State Health Foundation (NYSHealth) is committed to improving the health of all New Yorkers by informing health care policy and practice, spreading programs that work to improve the health system, serving as a convener of health leaders across the State, and providing technical assistance to grantees and partners.

NYSHealth is seeking to elevate conversations about health care transparency tools and maximize any investments in developing a tool through the awareness of existing tools. This is particularly pertinent as New York strategizes the use of its All Payer Database (APD)[1], Provider Network Data System (PNDS), and other data resources. To this aim, NYSHealth partnered with HonestHealth to conduct a national inventory of health care transparency tools, and HonestHealth contracted with the Human Services Research Institute (HSRI) to summarize findings and recommend next steps. 

Health Care Transparency Tools

Given the rising costs of health care insurance and services, consumers are being tasked to make more decisions about the coverage and care they want, need, and can ultimately afford—with the hope that it is also high quality. Health care transparency tools aid consumers in making these decisions and serve as a resource for providers, employers, researchers, and others. While the information comes in many forms—websites, mobile apps, print advertising, and broadcast media—they are most frequently websites. For the purposes of this brief, we use the term “tools” to specifically refer to health care transparency websites.

Transparency tools assist consumers in making value-based health care decisions by shining light on what they may pay for health care services and the quality of care they can expect to receive. Health care providers use the tools as a benchmark for improvement by comparing the care they provide to others. Employers utilize the information when making decisions on group insurance plans. Insurers, including self-funded employers, use the information for contracting purposes and to incentivize plan participants to visit lower-cost providers who offer the same or higher-quality care than higher-cost providers. Researchers and government agencies analyze the data and advocate for policy and system change. These engagement efforts not only increase education and drive conversations, they can also lead to continuous improvement.

Empowering Consumers

The complexities and costs associated with health care can quickly lead to information overload and decision fatigue, resulting in difficulty understanding issues and effectively making decisions. Transparency tools seek to minimize these barriers and instill confidence in the decisions being made. Consumer-friendly tools—those carefully designed with the end-user in mind—engage and empower consumers by helping them understand the meaning and relevance of the data and more easily relate the information to their own care.[2] Moreover, when cost and quality data are integrated, consumers are better equipped to evaluate the value of health care services and make more informed decisions. These tools encourage comparison shopping on where to purchase or receive care and help consumers avoid unexpected surprises.

Key Best Practices for Creating a Health Care Transparency Tool

This brief features tools that met the most criteria during the inventory; however, the tools do not necessarily represent best practices for health care public reporting. To document as many tools as possible, tools were inventoried by feature and were not explicitly evaluated on ease of use, understandability or the integrity of measure methodologies. When creating and maintaining a transparency tool for New York, stakeholders should reference tools that incorporate recommended best practices:

  1. Ease of Use and Innovative Features promote utilization. Sites should adhere to best practices for consumer-focused user interface designs. For example, summarization through word icons and symbols to reduce cognitive burden and quickly communicate performance.[3] Results should be presented side-by-side to ease comparison of multiple provider and treatment options. To help users find, understand and use the information, it is important to invest in responsive web design, search engine optimization, and content creation.
  2. Consumer and Provider-Specific information should be used to drive actionable transparency. Presented information should be available at the individual provider (physician or hospital) level rather than as geographic average rates. Studies have shown that consumers want doctor-specific information in addition to hospital-level information. Where possible, cost estimates should be specific to an individual’s insurance carrier and plan. Transparency is more actionable when it is more specific.
  3. Cost Data should be based on a dollar amount that represents the total amount paid for a service by both consumers and insurers, as derived from payment data from commercial claims. The data should help consumers determine an estimated total price paid, and where possible, the amount a consumer can expect to pay out-of-pocket (i.e., deductible, co-pay) for a health care service or prescription. To help consumers readily understand the information and relate it to their personal situation, the site should provide information on bundles of care and what is included in the estimated costs.
  4. Quality Data should be based on methodologically sound measures that consumers care about, such as patient-centeredness, effectiveness, safety of medical procedures.[4] Sites should consider using nationally accepted quality measures such as those outlined by the National Quality Forum and patient-generated unstructured reviews. Quality measures should be defined, organized in a framework, and clearly distinguish good and poor performers.[5] To increase value and relevance to multi-stakeholder audiences, tools should provide comprehensive clinical quality of care information in multiple categories and clearly define the methodologies.
  5. Represent Value by presenting cost and quality side by side to guide consumers away from the common misconception that high prices indicate high quality of care. When displayed appropriately, this presentation makes it easier for consumers to determine the best value option.
  6. In-Network and Out-of-Network information should be included when look at cost and quality information as one of the most important features identified by consumers when searching for care.
  7. Health Insurance sites should show the cost of the plan based on information tailored to the individual or household members, including any subsidies that may be available. Insurance plan options should provide information on whether hospitals, practices, or providers are in-network or out-of-network. The tools should also allow users to compare quality, benefits, and costs—including estimated drug costs—across plan options and filter by those that are compatible with a Health Savings Account (HSA).
  8. Building an Audience has proven challenging for transparency tools, as reflected in low utilization rates. Building a website alone is insufficient to foster changes in consumer behaviors—public outreach efforts, content generation, and coordination with existing user channels are needed to educate and engage audiences in the sites.

[1] For the purposes of this report, we are using APD synonymous with APCD (All Payer Claims Database), which is the underlying data source for a number of health care transparency tools. 

[2] Hibbard JH & Pawlson LG. Why Not Give Consumers a Framework for Understanding Quality? Joint Commission Journal on Quality Improvement 2004 June. 30(6); 347-351.

[3] Hibbard, J. & Sofaer, S. (2017, June 06). Best Practices in Public Reporting No. 1: How To Effectively Present Health Care Performance Data To Consumers. Retrieved from https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/pubrptguide1/pubrptguide1.html#relevant

[4] Hibbard, J.H., Greene, J., and Daniel, D. (2010). What is Quality Anyway? Performance Reports that Clearly Communicate to Consumers the Meaning of Quality of Care, Medical Care Research Review, 67(3), 275-293.

[5] Swift, E.K., Singer, R.F., Wu, T., Catterson, R.S., Johnstone, C., Alexander, T., Clavell, N., Dembo, R. & Green, M. (2013). Environmental Scan: Public Reporting of Health Quality and Efficiency Data under the U.S. Department of Health and Human Services, Prepared for the Office of the Assistant Secretary for Planning and Evaluation, U.S Department of Health and Human Service (ASPE/HHS) by NORC at the University of Chicago; Healthcare Financial Management Association, 2014

  •  Yegian JM, P Dardess, M Shannon, and KL Carman. Engaged Patients Will Need Comparative Physician-Level Quality Data and Information about Their Out-of-Pocket Costs. Health Affairs 32(2): 328–37, 2003.

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