Price Transparency and Reference Pricing

Our patients have no clue about cost and pricing in healthcare. Imitating other industries by creating pricing reference for different tests and procedures and maybe even creating charts with fluctuating prices depending on demand day/time of the week.

As we see other business trying to actively participate in Healthcare delivery, health systems have struggled in coming up with predetermined prices for customers.

In the age of “High Deductible Insurance Plans” (HDP), we need to determine what it costs to deliver care and then post our prices for the public to know. In some instances, we may not be the cheapest provider in the market, so we have to differentiate by creating and communicating value in what we offer. Health systems can entice their patients by offering one-stop-shop and one medical record but when it comes to pricing we need to be able to communicate ahead of time and at the same time making the experience an easy one.

I am looking for solutions and also if anyone is working on this. I know insurance companies are gathering data and sharing with their customers but we need to make a case by exposing our own prices with a value-added proposition.


Oil and Water


Strategic vs Operational Management

Participant comments on Price Transparency and Reference Pricing

  1. Hi Aldo. We have found this VERY challenging in our system. Even pricing for relative “commodity” services like labs and imaging are difficult to publish, as the “price” will vary based on the patient’s insurance contract. The “cost” of a specific MRI for a medicare patient may be $300, for private insurance X, it is $500 and for private insurance Y, it is $800. So we cannot just list prices as is done in other markets that don’t have an insurance company between the provider and the consumer.

    We have started to at least communicate the cost directly to each patient, depending on their insurance. This ends up being one-to-one communication that doesn’t fit with marketing strategies in most industries. Then it is up to the patient to shop around based on their insurance plan. Clearly this is more onerous to the patient, than being able to pull up a website to compare costs, but in our system where we cannot share contract information with other providers, it seems like the best we can do currently. I am looking forward to hearing other responses to your dilemma.

  2. Less than ideal, but what about listing cash pay prices w a disclaimer about calling for specific patient responsibilities based on different coverage models, and then linking to a chat window like we see on some consumer sites, lowering the barrier to immediate feedback on the information? I heard recently that some insurers are actively reaching out to their patients who are scheduling/pre authorizing an MRI for example and giving them a list of locations along w the pricing at those locations. They might be willing to help resource such a thing for their insured as it would be in their interest to increase insured awareness, but that does introduce some risk that they redirect away from our facilities. Wonder if possible to do some integration w their sites for specific procedures’ pricing.

    The meds alternatives functionality from Epic is a step in this direction w meds though there are limitations currently as it can only program one payer plan across all patients.

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