New Grants Examine Use of Price Data in Health Care

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The Robert Wood Johnson Foundation’s Quality/Equality Team, with support from the Changes in Health Care Financing and Organization (HCFO) Initiative, is pleased to announce it has awarded six grants that will explore the use of price data in health care.

Funded under the “Understanding the Use and Impact of Price Data in Health Care” solicitation, the grants aim to provide reliable, generalizable evidence to policymakers and delivery system leaders about the effective use of price information, including price transparency initiatives targeting providers and consumers.  Despite significant growth in the availability and use of price data over the past several years, many questions remain about the best way to present price information to various types of consumers, how best to combine cost and quality information, and how providers respond to price transparency initiatives.  The projects funded under this solicitation seek to address these and other important questions, with the goal of helping to accelerate the effective use of price information.  In order to assure the policy relevance of the work, the projects will benefit from the guidance of potential users of the final work at the outset and over the course of the studies.

Overviews of each project are provided below; additional information is available by following the links within the project titles.

The Impact of a Customized Price Transparency Tool on Consumer Behavior
Alison Cuellar, Ph.D., George Mason University

The researchers will evaluate a customized price transparency tool offered by a large national insurer. They will use enrollment, claims and web utilization data from the insurer, and focus on a broad range of clinical conditions in order to (1) identify the salient characteristics of tool users; and (2) estimate the impact of tool availability on provider choice, service utilization, and costs.  The goal of this project is to inform ongoing and future price transparency policies, including the use of consumer information tools.

Impact of Price Transparency Tools on Consumer Behavior
Anna Sinaiko, Ph.D., Harvard School of Public Health

The researchers will evaluate the effects of the Aetna Member Payment Estimator (MPE), a web-based transparency tool that provides personalized, real-time, service-level estimates of consumer out-of-pocket and total costs for over 500 common, non-emergent services to Aetna enrollees. The researchers will use enrollment, eligibility, and other MPE data, as well as data from the Area Resource File to (1) analyze the characteristics of members who used and did not use the MPE; (2) analyze the impact of the MPE on provider choice, out-of pocket spending and total spending; and (3) identify patient, plan and health care service characteristics associated with greater use of the MPE.  The goal of this project is to inform ongoing and future price transparency policies, including the use of consumer information tools.

Can Health Care Price Transparency Lead to Consumer Choice of Less Costly Care?  A High Deductible Health Plan as an Experiment
Elaine Swift, Ph.D., National Opinion Research Center, University of Chicago

The researchers will study how employees of the Cerner Corporation, a health care consulting firm headquartered in Kansas City, Missouri, respond to an e-tool that sends customized messages about potential savings opportunities, price comparisons, and quality metrics associated with their high deductible health plan (HDHP). Using claims, survey, and utilization data, the researchers will compare cost savings, employee characteristics, and quality of care for employees who opted to receive customized messages versus the comparison group of employees who did not.  The goal of this project is to learn how employees covered by HDHPs respond to transparency interventions and to explore ways to encourage informed shopping for health care coverage.

Public Perspectives on Price Data: Patterns of Use, Perceived Abilities and Broader Attitudes
Carolin Hagelskamp, Ph.D., Public Agenda Foundation, Inc.

The researchers will examine consumers’ opinions, preferences, current habits, barriers, and needs with regard to price data and price data tools.  Using data from a national survey, interviews, and focus groups, they will address three sets of questions: (1) What are people’s attitudes, concerns and opinions on price transparency and price data? (2) How, from what sources, and under what circumstances are Americans already accessing price data and how do early adopters evaluate the price data tools they use? (3) What are people’s preferences regarding price data?  The goal of this project is to generate nationally representative benchmarks of consumer use of and perspectives on price data and price data tools, and to inform policymakers, health care providers, consumer groups, employers and insurers on appropriate strategies to engage consumers with price data.

The Effect of Point-of-Care Price Information on Physician Ordering Behavior and Clinical Decision-Making
Alyna Chien, M.D., Boston Children’s Hospital

The researchers will evaluate the impact of a physician-targeted price transparency program on physicians’ test ordering rates, care quality, and use of price information in clinical decision-making and conversations with patients.  The researchers will conduct a randomized controlled trial at a large multispecialty group practice in which physicians will receive alternate versions of the same price information at the time of test ordering.  Following the intervention, the researchers will conduct semi-structured interviews with randomly-selected physicians from each study arm.  The goal of this project is to inform future health policy efforts aimed at engaging physicians to act as stewards of health care resources.

Effects of Physician Concentration, Physician-hospital Integration, and ACOs on Prices in Commercial Health Care Markets
J. Michael McWilliams, M.D., Ph.D., Harvard Medical School

The researchers will estimate the impact of physician concentration, physician-hospital integration, and accountable care organizations (ACOs) on prices paid for physician services. They will use Truven MarketScan claims data from large employers to construct price indices at the market level for a representative set of physician services. They will also use American Medical Association (AMA) Group Practice (GP) data linked to Medicare claims via national provider identifiers to measure market share of provider groups, a claims-based metric to measure physician-hospital integration, ACO provider networks and linked claims to measure ACO penetration and American Hospital Association (AHA) data to examine hospital market concentration. The goal of this project is to inform regulatory policy discussions of provider concentration and integration.