Patients using transparency tools skew younger, have fewer comorbidities

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In a study published in HealthAffairs, patients who searched for price information through Aetna’s Member Payment Estimator were significantly more likely to be younger and healthier and to have acquired higher annual deductible spending than patients who did not search for price information.

The need for transparency in healthcare prices is increasing and in an attempt to make value based decisions patients are encouraged to use these transparency tools. The study, looking at the period 2011 – 2012, was used to measure and provide evidence on whether and how patients use these healthcare price transparency tools.

Using the Aetna’s Member Payment Estimator (a web-based tool that provides real-time, personalized, episode-level price estimates) the study evaluated the experiences of 616,779 enrollees, of whom 332,255 searched the Member Payment Estimator; 159,909 were randomly selected nonsearchers; and 124,615 were enrollees who received a service in 2011–12 for which price estimates were available on the Member Payment Estimator, but who never used the tool.

To improve the precision of the study the sample was limited to adults ages 19–64, where researches were able to observe health status and out-of-pocket spending to people enrolled for at least seven months in a given year.

Variables in the study measured patient age, sex, category of eligibility (single or family coverage), annual deductible spending, location of residence, and comorbidities (which were measured using the Elixhauser comorbidity index). “For Member Payment Estimator searchers we obtained a record of every search (conducted either by the member or by a family member or customer service representative on the member’s behalf), the date of the search, and the service searched for,” wrote Anna D. Sinaiko, PhD, and Meredith B. Rosenthal, PhD, of the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health.

In the first year that the Aetna estimator was available, 112,372 subscribers (1.6 percent of those eligible) used the tool to get a price estimate for themselves at least once. The use increased by 43 percent in the second year, to 160,307 subscribers (2.4 percent of all those eligible). The majority of subscribers used the tool only once, meaning 3.5 percent of subscribers used it one time in 2011–12.

Of that group, the top 20 services searched in each year collectively represented about half of all searches. Preventive screening services (colonoscopy and mammogram) were the two most common services searched in 2011 and the first and third most common in 2012, together accounting for 15 percent of searches in 2011 and 14 percent in 2012. Other common searches included were obstetrical care, physician office visits, and selected outpatient procedures.

The study concluded that, although the use of the tool increased during the study period, it remained relatively low. “Nonetheless, for some procedures the number of people searching for prices of services...was high relative to the number of people who received the service,” wrote Sinaiko and Rosenthal. Patients who searched for price information were more likely to be younger, users of medical care, and to have fewer comorbidities compared to patients who did not use the transparency tool. Services searched for most often were planned, not emergency, services.

Although the study showed low use, the proponents of price transparency hope that healthcare price information will become an important part of patient decision making. Patients will be able to choose high quality, high value care, which will influence spending and utilization in a bigger way. “The findings suggest that to achieve this goal, innovative approaches to engaging more consumers with these tools may be the next critical frontier for price transparency”, wrote Sinaiko and Rosenthal.