Hospital Price Transparency Stakeholder Meeting
Stakeholders gather to discuss hospital pricing data transparency, analyze price variations, and strategize actions for achieving greater healthcare value. The meeting agenda includes introductions, problem overview, RAND Hospital Price Transparency Study results, key findings, state-wide pricing trends, and coalition's next steps. Utilize the provided agenda template and tools for effective collaboration.
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Presentation Transcript
Making Use of Hospital Price Transparency Data Stakeholder Meeting in <MARKET> <Meeting Leader Name> <Meeting leader title and company> <Meeting leader contact information The contents represent the views of the authors and not the organization or it s funders
DELETE THIS SLIDE PRIOR FROM ACTUAL PRESENTATION INSTRUCTIONS FOR USING THIS DECK This deck is designed to guide a preliminary discussion with a coalition of health care purchasers who wish to collaborate to achieve greater health care value, using the RAND 2.0 Hospital Price Transparency Study Beginning at slide 10, you will find tables and charts that are populated with sample data. You can customize these slides using the charts and graphs contained in the Data File Stakeholder Deck Excel Tool. Slide 16 references a Pre-meeting Survey Tool. The survey tool is designed to help you gather information about your coalition partners and their preferences prior to the first meeting. The survey can also help you populate slide 4 (Who We Are). The pre-meeting survey is entirely optional.
AGENDA Roundtable introduction of meeting participants (5 min) Problem Overview (10 min) Hospital price variation and price inflation RAND Hospital Price Transparency Study Hospital Pricing Data Results for <Market> (20 min) Key findings (state-wide) Individual hospital price results by site of service State-wide price trends: 2015-2017 Next steps for our coalition (25 min) Results from pre-meeting survey: strategy preferences Taking action: next steps
WHO WE ARE ## Organizations, comprising ## employees and ## covered lives <insert any additional information as relevant>
STATE OF THE NATION: HEALTH CARE UTILIZATION IS FLAT/DECLINING BUT PRICES CONTINUE TO CLIMB Inpatient Inpatient 1.20 Outpatient Outpatient 1.20 1.20 1.20 1.15 1.15 1.15 1.15 1.10 1.10 1.10 1.10 1.05 1.05 1.05 1.05 1.00 1.00 1.00 1.00 0.95 0.95 0.95 0.95 0.90 0.90 0.90 0.90 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016 Price Utilization and Intensity 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016 Price Utilization and Intensity Price Utilization and Intensity Price Utilization and Intensity Health Care Cost Institute. (2018). 2016 Health Care Cost and Utilization Report. Retrieved from http://www.healthcostinstitute.org/report/2016-health-care- cost-utilization-report/. Prices are from Appendix Table A3,, utilization and intensity is estimated by dividing spending (from Appendix Table A1) by prices.
PRICES VARY DRAMATICALLY ACROSS THE COUNTRY, AND ARE UNCORRELATED TO QUALITY OF CARE Medicare Hospital Quality Score vs. Inpatient Spending per Beneficiary Average Hospital Prices Relative to Medicare, 2017 Source: White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative Commonwealth Fund: https://www.commonwealthfund.org/health-care-quality-spending-interactive#?chart=medicare&s=hospitals&ci=c020&qi=Hospital&loc=HRRs&viz1=scatter&viz2=map&filterState=
7 RAND 2.0 National Hospital Price Transparency Study of 25 states Conducted by RAND, commissioned by Employers Forum of Indiana Services Hospital inpatient, hospital outpatient States CO, FL, GA, IL, IN, KS, KY, LA, MA, ME, MI, MO, MT, NH, NC, NM, NY, OH, PA, TN, TX, VT, WA, WI, WY Years 2015-2017 Hospitals 1598 short-stay general medical/surgical Allowed amount (2015-7) $12.9 billion in payments ($6.3 billion inpatient, $6.6 billion outpatient) Claims (2015-7) 330,000 claims inpatient, 14.2 million outpatient line items Data sources 2 all payer claims databases, many health plans, ~45 self-funded employers Funders RWJF, NIHCR, THFI, self-funded employers (not health plans or hospitals) Source: White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative
STUDY APPROACH Obtain claims data from Measure prices in two ways -Relative to a Medicare benchmark -price per casemix weight Create a public hospital price report Create private hospital price reports for self- funded employers -Optional for employers -Self-funded employers -APCDs -health plans -Will be posted online, freely downloadable -named facilities and systems -inpatient prices and outpatient prices
TWO WAYS HOSPITAL PRICES ARE MEASURED adjusted for comparable across service lines ??????? ?????? casemix local wages teaching uncompensated care 1. Relative prices = ????????? ???????? ??????? ?????? =??????? ?????? ??????? ???? ?? adjusted for not comparable across service lines 2. Price per casemix weight casemix
KEY FINDINGS FOR <MARKET> The average hospital price in <MARKET> is 311% of what Medicare charges; average inpatient prices are 336% of Medicare, and outpatient prices are 403% of Medicare Prices range from 111 543%, and 54% of hospitals in the state are >=250% of Medicare rates Highest Priced Hospital Lowest Priced Hospital Average Hospital Price Number Medium Cost Percent Medium Cost Hospitals (150-250% Hospitals (150-250% Relative to Medicare Relative to Medicare Relative to Medicare Number Low-Cost Number High Cost Percent High Cost Percent Low Cost Hospitals (<150% Hospitals (<150% Hospitals (>250% Hospitals (>250% Medicare) Medicare) Medicare) Medicare) Medicare) Medicare) Service category Inpatient 236% 397% 68% 30 25% 60 50% 90 15% CUSTOMIZE USING DATA FILE Outpatient 403% 614% 108% 2 2% 25 21% 27 76% Inpatient plus outpatient 311% 543% 111% 103 87% 40 34% 43 54% Source: Derived from Supplement, White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer- Led Transparency Initiative. *NOTE: thresholds for high, medium and low-priced hospitals established by RAND Corporation
<MARKET>: TOTAL Hospital Commercial Prices 2017 (inpatient plus outpatient) CUSTOMIZE USING DATA FILE Source: Derived from Supplement, White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative
<MARKET>: INPATIENT Commercial Prices 2017 CUSTOMIZE USING DATA FILE Source: Derived from Supplement, White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative
<MARKET>: OUTPATIENT Commercial Prices, 2017 CUSTOMIZE USING DATA FILE Source: Derived from Supplement, White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative
<MARKET>: Trend Data Relative to Medicare Relative to Medicare2015 2017 CUSTOMIZE USING DATA FILE Source: Derived from Supplement, White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer-Led Transparency Initiative
INDIVIDUAL HOSPITAL RESULTS IN <MARKET> Total Private Allowed Outpt. ($ millions Total Private Allowed Inpt. ($ millions Total Private Inpt. and Outpt. (# millions) Relative price for Inpt. and Outpt. services Number of Outpt. services Relative price for Outpt. Services Stand. price per Outpt. service Relative price for Inpt. services Stand. price per Inpt. stay Simulated Inpt. and Outpt. ($ millions) Hospital Compar e Star Simulated Medicare Outpt. Number of Inpt. stays Simulated Medicare Inpt. Hospital name Parkview Regional Medical Center 3 34863 30.1 5.8 515% $353.93 2401 18.1 6.5 280% $17,359 48.2 12.3 392% Eskenazi Health 4 5494 CUSTOMIZE USING DATA FILE 1.0 .3 332% $249.98 375 2.1 1.3 157% $14,679 3.1 1.6 189% Indiana University Health 3 61214 33.5 7.0 475% $359.29 4431 52.8 21.1 249% $24,954 86.2 28.2 306% Source: Derived from Supplement, White, 2019, Prices Paid to Hospitals by Private Health Plans are High Relative to Medicare and Vary Widely-Findings from an Employer- Led Transparency Initiative.
RESULTS FROM Q7 OF THE PRE-MEETING SURVEY: STRATEGIES COALITION MEMBERS ARE CONSIDERING CUSTOMIZE USING DATA FILE
RESULTS FROM Q8 OF PRE-MEETING SURVEY: STRATEGIES COALITION MEMBERS ARE OPEN TO PURSUING TOGETHER CUSTOMIZE USING DATA FILE
NEXT STEPS What is our preferred strategy? What resources do we need to implement this strategy? What should be our meeting cadence and timeline for achieving our goal? STRATEGY Pressure outlier providers Media strategy re outlier providers Provider network Policy Other TACTICS RESOURCES NEEDED TIMING
