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This Week in Health Care Reform: August 10th, 2018

The Administration finalizes new price transparency rules; stakeholders continue to draw attention to the rising cost of care; experts point out what’s needed to make value-based care models work; and, data interoperability requires trust between parties to be effective.

Week in Review

Price Transparency: In a new rule finalized late last week by the Administration, hospitals will now be required to post a list of their standard charges online.  While already required to provide this information upon request, beginning January of next year, under the new rule, hospitals will have to make this price information available online and updated annually.  In finalizing the rule, the Centers for Medicare & Medicaid Services (CMS) said the goal was to not only "encourage price transparency" but, improve "public accessibility", as well.  Additionally CMS said it is exploring other ways in which to "allow consumers to more easily access relevant health care data and compare providers."

Cost of Care: As consumers, employers, and governments increasingly find themselves having to grapple with rising health care prices, a commensurate level of attention is being paid to rising health care costs – and, perhaps more notably, what’s driving them.  For example, in North Carolina, after balking at the astronomical price quoted to him for a routine medical scan by a hospital, one doctor decided to open his own imaging center, in an attempt to wrest monopolistic control over MRI scans and other services away from hospitals.  Unfortunately, his efforts were thwarted by the state’s "certificate of need" laws, which effectively serve to protect hospitals from competition.  At one time, 49 states had these laws on the books.  But, since their inception 40 years ago, more than a dozen have repealed theirs.  Separately, stakeholders have also recognized the role that emergency room (ER) overutilization plays in driving up health care costs, standing as one of the most egregious examples of the inefficient and costly use of health care services.  In fact, according to one analysis, as much as 27 percent of all ER visits could be treated in retail or urgent care clinics, which could potentially reach annualized savings upwards of $4 billion.

Value-Based Models:
Consumer expectations regarding health care delivery continue to reshape our existing model.  More broadly, these dynamics have resulted in the gradual shift away from traditional fee-for-service and towards more value-based care.  One place where this is particularly felt is in the makeup of the health care workforce.  As health systems remake themselves in the image that best resonates with consumers, the lack of a clear definition for value-based care poses challenges to how exactly that translates into a consumer-oriented model.  While technology undoubtedly has a role in helping our health care system writ large accelerate this transition, there’s growing recognition that a better-educated, patient-centered workforce, with fluency in the value-driven concepts already at work throughout the system, has a critical part to play, too.

Data Interoperability:
The exchange of information has long been touted as being one of the keys to unlocking the potential of our rapidly evolving, interconnected health care system, particularly as it relates to value-based care.  However, administrative burdens have long complicated our ability to fully leverage the benefits of data mining.  As these have eased, though, what’s established itself as a persistent barrier to interoperability has been the inability amongst stakeholders to find their way to a collaborative spirit of shared enterprise.  From an execution standpoint, that’s shown itself to be problematic in areas such as getting systems to communicate with each other.  While experts suggest that standardization would encourage greater collaboration, others say it ultimately comes down to a matter of trust between partners.

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