HealthIT

New Hampshire's creation of a price transparency website for health care services suggests publishing payment rates can affect negotiations between insurers and providers, Modern Healthcare reports.

Background

New Hampshire's HealthCost website uses information from the state's all-payer claims database -- the Comprehensive Health Care Information System -- to provide consumers with estimates of insurer and out-of-pocket costs for health care services.

The website, which launched in February 2007, aims to define the real prices of health care services. In the last quarter, about 2,800 individuals visited the website.  

Earlier this month, New Hampshire earned the only "A" grade in the Catalyst for Payment Reform and Health Care Incentives Improvement Institute's annual report card highlighting state transparency efforts.

Results From N.H. Initiative

Although NH HealthCost was designed for consumers, insurers and providers have an especially critical stake in the initiative. 

According to Modern Healthcare, New Hampshire's price transparency initiative has spurred new models for insurance plan benefits, prompting consumers to seek out lower-cost care settings and hospitals to provide patients with more affordable care settings. HealthCost also has driven insurers to offer incentives to members who choose lower-cost care sites, such as an ambulatory surgery center instead of a facility within a hospital.

A 2014 study conducted by Mathematica Policy Research found the price transparency initiative is at least partly responsible for health plan designs in New Hampshire to develop faster than those in other areas of the U.S., and has forced several high-cost providers to lower their rates.

Critics note that New Hampshire's initiative is limited by a lack of competition among hospitals in the state. However, as more states seek to increase pricing transparency, New Hampshire's effort is being seen as a model (Kutscher, Modern Healthcare, 7/18).

CMS issued a proposed rule for the 2016 Medicare home health prospective payment system that encourages home health agencies to accelerate their adoption of health IT, Health Data Management reports (Goedert, Health Data Management, 7/8).

Details of Proposed Rule

According to AHA News, the proposed rule would reduce home health payments by 1.8% from 2015 levels (AHA News, 7/6). The proposal also would impose a value-based purchasing model on all Medicare-certified home health agencies in nine states as part of a pilot program.

In addition, the proposal would:

• Enforce a 1.72 percentage point cut in calendar year 2016 and CY 2017 to the standardized 60-day episode payment rate (Health Data Management, 7/8); and
• Establish the third year of a four-year "rebasing" of the standardized 60-day home care episode rate in an effort to recover overpayments (Dickson, Modern Healthcare, 7/7).

Health IT Implications

Citing the Office of the National Coordinator for Health IT's interoperability roadmap and the draft 2015 Interoperability Standards Advisory, CMS in its proposed rule encourages home health agencies to use electronic health records and health information exchange (Durben Hirsch, FierceEMR, 7/7).

CMS notes that doing so would result in greater success for the organizations, adding that "effective adoption and use of health information exchange and health IT tools will be essential as these settings seek to improve quality and lower costs through initiatives such as value-based purchasing."

The agency adds, "As adoption of certified health IT increases and interoperability standards continue to mature, HHS will seek to reinforce standards through relevant policies and programs" (Health Data Management, 7/8).