Network Provides Healthcare Pricing Data - InformationWeek

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11/20/2009
12:44 PM
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Network Provides Healthcare Pricing Data

Transparent Health Network negotiates healthcare pricing with medical providers, and shares price data with its members online.

One of the factors driving up healthcare costs is lack of price transparency. When patients go to a healthcare provider, they don't know in advance how much they're going to spend, and they don't know how to tell whether a procedure is priced reasonably.

Transparent Health Network is looking to change that, starting in the New York metropolitan area, using Internet technology.

The service, which went online Nov. 1, is designed for uninsured and underinsured people. It negotiates pricing with healthcare providers just like an insurance company does, but unlike an insurance company, members of the service pay the provider directly. The service also includes a Web site where members can look up pricing in advance, so they can figure out what they can expect to pay before they go in for a procedure.

"One of the primary goals of Transparent Health Network is to create a better educated and better informed consumer and one of the most important parts of this is price transparency," said Andrew Rieger, VP of operations and technology for the company.

The Web-based service gives members access to a set of fee schedules for various procedures, organized in a way that's relatively accessible, Rieger said. Members can look up common procedures, like a checkup, pediatrician visit, or vaccination, and see the fees that individual doctors will charge for those activities. For example, a 30-minute preventative office visit is $104.37.

The fee schedule is also organized by specialist, with subcategories for typical procedures.

In a future version, the company plans to partner with a medical database company to connect established procedures with clinical events, and assemble packages of procedures, with pricing for typical conditions. "When you go to a doctor's office, you may think you know what's going to happen, but you don't know all of it. There's only so much a non-medical person can know," Rieger said.

For example, in the next version of the service, a member will be able to look up a broken arm, and find that it typically requires a level 3 visit, with X-ray and casting procedure, and get pricing for the entire package of services.

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