Christopher Whaley

Association Between Availability of Health Service Prices and Payments for These Services

IMPORTANCE Recent governmental and private initiatives have sought to reduce health care costs by making health care prices more transparent. OBJECTIVE To determine whether the use of an employer-sponsored private price transparency platform was associated with lower claims payments for 3 common medical services. DESIGN Payments for clinical services provided were compared between patients who searched a pricing website before using the service with patients who had not researched prior to receiving this service. Multivariable generalized linear model regressions with propensity score adjustment controlled for demographic, geographic, and procedure differences. To test for selection bias, payments for individuals who used the platform to search for services (searchers) were compared with those who did not use the platform to search for services (nonsearchers) in the period before the platform was available. The exposure was the use of the price transparency platform to search for laboratory tests, advanced imaging services, or clinician office visits before receiving care for that service. SETTING AND PARTICIPANTS Medical claims from 2010-2013 of 502,949 patients who were insured in the United States by 18 employers who provided a price transparency platform to their employees. MAIN OUTCOMES AND MEASURES The primary outcome was total claims payments (the sum of employer and employee spending for each claim) for laboratory tests, advanced imaging services, and clinician office visits. RESULTS Following access to the platform, 5.9% of 2,988,663 laboratory test claims, 6.9% of 76,768 advanced imaging claims, and 26.8% of 2,653,227 clinician office visit claims were associated with a prior search on the price transparency platform. Before having access to the price transparency platform, searchers had higher claims payments than nonsearchers for laboratory tests (4.11%; 95% CI, 1.87%-6.41%), higher payments for advanced imaging services (5.57%; 95% CI, 1.83%-9.44%), and no difference in payments for clinician office visits (0.26%; 95% CI; 0.53%-0.005%). Following access to the price transparency platform, relative claim payments for searchers were lower for searchers than nonsearchers by 13.93% (95% CI, 10.28%-17.43%) for laboratory tests, 13.15% (95% CI, 9.49%-16.66%) for advanced imaging, and 1.02% (95% CI, 0.57%-1.47%) for clinician office visits. The absolute payment differences were

Accountable Care Organizations in California: Market Forces at Work?

3.45 (95% CI,

Reference Pricing, Consumer Cost-Sharing, and Insurer Spending for Advanced Imaging Tests.

1.78-

Association of Reference Pricing with Drug Selection and Spending

5.12) for laboratory tests,

Searching for Health: The Effects of Online Price Transparency

124.74 (95% CI,

PS2-18: Functional Limitations, Home Support, and Responses to Drug Costs Among Medicare Beneficiaries.

83.06-

Firm Responses to Targeted Consumer Incentives: Evidence from Reference Pricing for Surgical Services

166.42) for advanced imaging services, and

Consumer Responses to Price Transparency Alone Versus Price Transparency Combined with Reference Pricing

1.18 (95% CI,

Reference-Based Benefits for Colonoscopy and Arthroscopy: Large Differences in Patient Payments Across Procedures but Similar Behavioral Responses

0.66-

The Association Between Provider Price and Complication Rates for Outpatient Surgical Services

1.70) for clinician office visits. CONCLUSIONS AND RELEVANCE Use of price transparency information was associated with lower total claims payments for common medical services. The magnitude of the difference was largest for advanced imaging services and smallest for clinical office visits. Patient access to pricing information before obtaining clinical services may result in lower overall payments made for clinical care.