Pricing transparency: finding the intersection of cost and quality

“You get what you pay for” is a well-known axiom, but it has been a nonexistent concept in the health care industry for decades. Health plans have treated their reimbursement schedules as  a trade secret, and the federal government historically prohibited price transparency under the Sherman Act. 

The fact that the Centers for Medicare and Medicaid Services (CMS) now compels health plans to post negotiated rates is a sea change. With health plan pricing transparency, understanding value — the intersection of the cost and quality of a health care service — is possible, creating a potential game-changer for health plan sponsors, including employers, who were formerly in the dark. In turn, “bending the health care cost curve” is now not only possible, but also urgently needed. Ensuring that employees make informed choices about value is the only way for employers to receive “value for money” for their health care expenditures.