health care transparency

On June 24, President Trump issued The Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First. This order includes sweeping provisions that could have a significant positive impact on one of the cornerstones of The Alliance: the availability of information to assess and compare the quality and price of health care services.

On paper, there is a lot to like about this executive order. However, the rulemaking process is complex and subject to influence. It will take a strong show of support from employers and consumers to ensure that the intent of this order is achieved and the process by which it is implemented stays on track.

The order includes five initiatives:
  1. Public reporting of standard charges and negotiated rates for common, shoppable items and services. While reporting billed charges is nothing new, requiring the disclosure of negotiated rates is. The rates negotiated between insurance companies and doctors and hospitals are considered proprietary information by the industry, but this keeps the public in the dark about price differences. In addition, the order will solicit comments on a proposal to require providers, health insurers and self-funded group health plans to provide information about expected out-of-pocket costs to patients before they receive care.
  2. Developing a Health Quality Roadmap. This provision uses the power of public purchasing programs like Medicare and Medicaid to align and improve public reporting of health care quality measures.
  3. Increasing access to data. The order will facilitate the release of data (without patient identifiable information) from publicly funded health care programs for use by researchers, providers and entrepreneurs. Greater access to data will help researchers and providers identify ways to improve care. At the same time, access to this data will help the private sector develop new tools to support informed consumer decision-making.
  4. Expanding tax-favored health care reimbursement options.
  5. Addressing surprise medical bills by providing protection for patients who face out-of-network charges in emergency situations or due to other circumstances beyond their reasonable control.

The timeline for action is short. For instance, the Secretary of Health and Human Services has until Friday, Aug. 23 to propose a regulation to accomplish the first goal above of publicly reporting charge and negotiated price information. This provision, in particular, is likely to face strong objections from insurance and hospital lobbying groups.

The Alliance, with our health policy partners, will be monitoring the progress of this executive order and will promote opportunities for you to weigh in on this important initiative.

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Cheryl DeMars

Cheryl DeMars

President & CEO at The Alliance
Cheryl DeMars joined The Alliance in 1992, assuming several roles before becoming CEO in December 2006. Cheryl works with the Board of Directors and senior leadership team to establish the strategic direction of the cooperative.

Cheryl participates in a number of national and regional initiatives that align with The Alliance’s mission of controlling costs, improving quality and engaging individuals in their health. She serves on the Advisory Board of the Wisconsin Population Health Institute and the board of the Wisconsin Collaborative for Healthcare Quality.

Prior to joining The Alliance, Cheryl was a program manager at Meriter Hospital in Madison. She earned a master’s degree in social work from the University of Wisconsin-Madison.
Cheryl DeMars