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Navigating Price Transparency Requirements

Part Two - Price Transparency in Ohio


The Current State of Price Transparency in Ohio


Laying the Groundwork at MetroHealth of Ohio


Expanding State Laws in Ohio

Previous: Section 1 - Pros & Cons of Price Transparency Strategies
Next: Section 3 - Offering Patients a Self-Service Cost Estimate Tool


Transcribed Video Content Below

Today I'm going to talk about, primarily, what our journey has been within Ohio and based on the review of federal pricing transparency requirements, our situation has been very, very similar where we opted to take on multiple methods because of our patient population. Everyone has different preferences on how they want to get information, whether it's through talking with someone independently, trying to get information, and receiving information in writing. So we follow all of those types of situations.

Current State of Price Transparency in Ohio

Percentage of Patients Understanding of Costs Prior to a Medical VisitAs it relates to Ohio pricing transparency grades, I’m happy to say that Metro really would pass. It's really been since 2006 that Ohio has been requested to share pricing and we basically have done that on our web. We also are required by the Ohio Department of Health to provide our top 60 in-patient diagnoses, which are severity adjusted for DRG. Also, our top 60 outpatient services based on volume.

MetroHealth has used the Ohio Hospital Association as a partner to submit information to ODH. The sad part is ODH has decided not to aggregately take this information and provide comparisons as they did beyond 2010. I think one of those reasons may have been because the Ohio Hospital are required to post those same services on their website. So they determined that patients can get that information in other ways in addition to other hospitals being able to look at pricing.

We basically move into what has occurred since 2014 with the Affordable Care Act, which basically have caused major increases in deductibles for our patients. Although more people can be served with insurance through healthcare exchange, it's more difficult now for patients to actually afford their healthcare because the price sharing is much more expensive on their part based premiums that they select.

And as you can see here, Ohio is ranked in the top five. I'm pleased to say they were literally only second to Texas a couple years ago. So we are managing deductibles a little bit better. When this started to occur, Metro decided to actually provide a survey to the community in Cuyahoga County in other areas of Ohio including our own patients. And what we've found is that as much as patients want to be informed, they really don’t understand it enough to do the research. And this is showing you that out of a population of about 100 people responding, which was about 10% of the survey sent out, (which is not unusual), 34% never researched it.

Basically, almost 70% were going into their services without understanding what that cost would be to them and really what their insurance cost would be. Only 19% actually were proactive in looking and seeking out estimates. Assigning that this survey even more are seeking estimates, so that's a good thing. The more informed, the better the expectation is for the hospital and then also for the patient.

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Laying the Groundwork at MetroHealth

I just wanted to talk a little bit about Metro's pricing transparency and the history as I mentioned since 2006, at least, we’ve been publishing our rates. Basically, we've added in 2013, payer links so that our patients could actually go to our own website and based on their insurance they could tap a link and that would take them right to their insurance portal so that their own insurance company could provide them with an estimate.

We did it through our own website because we felt that it's very difficult to navigate to many of the payer portals. And we could provide guidance to the patient when they're in their own portal as to how to access it, what they’re actually looking for, and possibly define the different type of insurance jargon etc. that we may be accustomed to, but the patients are not.

We also discussed expanding our own estimate, not only to patients, but also to consumer advocacy groups like AARP, and also senior citizen groups. We started to get quite a bit of shoppers in 2013.

Although we are an essential hospital and we're in Cuyahoga County, we actually get international shoppers who may be moving to Ohio. And they're actually looking to deliver their children here. So they're looking for what are the gynecology what are the OB and the delivery pricing in addition to some other things that Metro is very much known for.

In addition, another venue that we use our letters to our Medicare patients so that they can see on average what our visit charges would be to see the provider, and also certain procedures that seem to be those that are most frequented by our Medicare patients. And this provides them information before their visits so that they can reach out to us with any questions. It also allows us the opportunity to talk to the Medicare patient to ensure that they may have enrolled in Medicare Part B or if they’ve chosen some other secondary insurance.

Key Factors for MetroHealth of Ohio in Selecting a PartnerOften times Medicare patients don't realize that they need to enroll nor that there's a cost associated with it, so we can facilitate with financial coordination. And then of course as mentioned, the traditional patient may call us, our Pre-Service Center that we give estimates by phone. And then we always confirm with a letter to our patients. So again, we have very many ways in which a patient or the consumer can contact us regarding patient estimates.

In order to be able to accomplish this, we feel it's very important to provide certifications and education for our staff, so that the community understands that we do have experts in the field to facilitate, providing estimates, providing financial coordination, and able to reach out to our community and patients so that we can be knowledgeable and feel confident in the information that we give them.

We have a total of 38 staff that are actually Certified Application Counselors. In addition to those staff prior to that, we're all certified access hospital associates and all our managers have the NAHAM Certification for hospital access. This allows our staff and professionals to feel confident about the information that they're providing and our patients and community to feel confident about their information they're getting to remove any financial barriers.

We also moved out in the community to become much more proactive and move away from ‘we’re just providing our patients information about pricing transparency and estimates’. And we are very fortunate that we had a 38-foot RV hospital at the hospital that was being used for other programs, but it wasn't being used on a regular basis.

So probably about three months out of the year it would be out on the road for clinical services. So what we did is we actually collaborated with the other programs and we turned it into an enrollment vehicle on wheels.

So instead of concentrating just on our sites where we had financial coordination, and ways to get patient assistance with either enrolling in insurance or financial programs, we literally staffed their RV, and we staffed it probably about 95% of the year, even in the wintertime as long as weather permits, so that we could educate patients on preventative care, continuity of care, and how they should not be concerned about not having coverage. Because that's what we're experts to do – to navigate them through healthcare exchange, Medicaid, and other financial programs that they may be eligible for, including financial assistance.

So basically, since March of 2014 when we launched the RV, we've literally assisted 4,000 people, and we were able to enroll 70% of those individuals in insurance programs. New patients to us who we didn’t have before the RV, we probably run at about a 10% enrollment of brand new patients.

This helped us provide preventative care and have a healthier community, but it also helped us with reducing expenses because patients’ acuity levels were lower going through preventative care, and it reduced the emergency visits that we were seeing. So we were taking care of the community as well as managing our expenses appropriately.

Then basically we've made sure that everybody understood, because you know you always have statistics that really all of these numbers are about people, and it’s about making a difference. And we saw that in our programs we were able to manage population health because we were managing diabetes and other acute care that was needed and helping people truly understand by modifying their lifestyles, by seeing a physician earlier, by having medical management right there for them, that it's not just about navigating their financial care but also navigating their clinical care.

Expanding State Laws in Ohio

As well as we thought we were doing, then we got involved, of course, with the 2015 ICP System and also Bill 52 that we needed to look at. And so we did a checklist basically of everything that we did and we thought we had a very robust checklist, including reaching out to the community. But where we felt that we could even do better, is being able to make the patient independent.

A lot of our patient focus groups, what people were frustrated about, is they appreciated the financial communications, they've appreciated us proactively reaching out to them, but they really wanted to be able to be independent and start to learn on their own and just like with all of the various websites, do research on their own.

And that's when we made a decision that it wasn't just about us be being proactively reaching out to patients or answering phone calls, it was to let them in the convenience of their own home to look to start understanding pricing transparency, and what their out-of-pocket costs would be, and how their insurance works, and what their bills potentially could be if they came to Metro.

So this is when we really started to talk about leveraging technology and it started as simple as it would be, it started to feel like it was becoming more complicated. So we reached out to individuals and advocacy groups and we started to talk about how we can have this independence and engage our consumer to be more knowledgeable. We actually put out an RFP and we were looking for a partner that would be able to provide us with a portal on our website where patients could do independent research and reference to their cost.

PMMC was awarded the RFP because of their flexibility in reference to being able to not only work within our staff requirements for estimates but also develop with us this online patient estimator portal that we're going to discuss. It was something that just came out of a box. It was truly collaboration with many of our teams so that we could discuss with communications, we could discuss with our IT team, we could discuss with our physicians, our patient advocacy groups, our patient focus groups. What does the patient truly, truly want to see?

So the way in which that we were managing the unknown was by reaching out and getting everybody else's questions answered. And having PMMC partnered with us to tailor something specific to patient estimates.

PMMC works with hospitals to establish a sound price strategy. Learn More today