Hospital Price Transparency Initiative

Learn what % of Medicare you pay at hospitals around the U.S. used by your employees and leverage that smart data with your plans and health systems to address rising in-patient and out-patient costs.

Summary: Every purchaser of group health insurance knows that the prices they are charged for hospital services is higher than what Medicare contracts for.  How much more is unclear, and that’s a disadvantage when negotiating in the market for fair prices.  

In a 2018 examination of hospital prices covering 1,598 hospitals in 25 states, The RAND Corporation found that  self-funded employers paid on  average 241% of what Medicare would have paid for the identical service, and the variation among states was vast.  Houston employers were represented in this benchmarking.

HBCH joined the national rollout of RAND 2.0 after a successful pilot in Indiana.  Nine self-funded HBCH employers participated.  The study was primarily funded by grants which allowed employers to participate at no cost or a nominal fee.  Employers were provided what they paid relative to Medicare for every service at every hospital at which their covered lives received care. 

Ongoing Results: Nine of HBCH employers participated in RAND 2.0.  In aggregate Houston employers paid more than 230% of Medicare and close to 300% for outpatient services.  Feedback from every employer was positive, with statements like, “ A game-changer for us,” and “Best opportunity for employers in two  decades.”

.HBCH has developed a Hospital Price Transparency Task Force.  It consists of employers, a renowned healthcare economist, a former health plan CEO, and other stakeholders’ intent on ensuring employers are charged fairly for hospital services.   HBCH is also working with the National Alliance of Healthcare Purchaser Coalitions to develop common approaches to address this inequity nationally.

Results of all previous rounds and to participate in future rounds click on this national site, https://employerptp.org/.  There is even a hover map where you can compare paid amounts at any hospital in the country from which claims data was obtained.  

RAND 3.0 is underway and 4.0 will be coming soon.    Most of the cost of this initiative is covered under grants from The Robert Woods Johnson Foundation, The Health Foundation of Greater Indianapolis, and The National Institute for Health Care Reform.  Therefore, employers can participate at no cost to receive an aggregate or pay a nominal fee to receive a customized report. ll. 

Want to get involved? Reach out to Chris Skisak, executive director at HBCH at [email protected]