“Reaching across Arizona to provide comprehensive quality health care for those in need” AHCCCS/ADHS Report Summary & Recommendations

“Reaching across Arizona to provide comprehensive quality health care for those in need” Required Reports  The FY 2014 Budget required AHCCCS and ADHS to provide a report on the current hospital chargemaster and make recommendations to improve transparency by January 1,  The 2015 Budget continued this requirement with a January 1, 2015 due date. The 2015 report will include results from stakeholder discussions and specific recommendations on transparency.

“Reaching across Arizona to provide comprehensive quality health care for those in need” 2014 Report Summary  In order for health care consumers to be able to assess value, as they do with other goods and services, THAT reliable and understandable price and quality information must be accessible  Charges alone provide a very limited perspective in the actual price paid by most consumers  The current Arizona Chargemaster reporting requirements serve no public good because the line item format of the data is not uniform and it is virtually inaccessible to the public

“Reaching across Arizona to provide comprehensive quality health care for those in need” 2014 Report Recommendations  While there are a number of options, the most successful initiatives have stakeholder input and support  AHCCCS and ADHS will convene key stakeholders with the goal of reaching consensus on ways to improve the availability of price and quality information in a format that is useful to consumers and payers and will provide a report by January 2015

“Reaching across Arizona to provide comprehensive quality health care for those in need” 2014 Report Recommendations (con’t) These stakeholder meetings will examine options for improving public access to data, including:  Establishing hospital reporting in a format that is useful to purchasers of health care services  Structuring uniform reporting requirements, so that a given charge or procedure at one hospital is comparable to that at another hospital  Including hospital outpatient services in addition to inpatient data  Making the data accessible thru a searchable website  Including prices for selected common diagnoses and procedures  Making charge and paid amounts for procedures and diagnoses available online or a public report  Determining strategies to make pricing available to patients prior to rendering of services

“Reaching across Arizona to provide comprehensive quality health care for those in need” 2014 Report Recommendations (con’t) AHCCCS and ADHS will employ the following strategies:  AHCCCS will be more transparent in sharing information on hospital billed charges and the payment amounts made by AHCCCS for common inpatient and outpatient procedures  AHCCCS will also be working toward making similar information on other types of providers for common procedures available in the future  ADHS will continue to update AZ Hospital Compare as data becomes available  ADHS will continue to annually update and post hospital quality information  AHCCCS and ADHS will review their various transparency initiatives to consolidate or aggregate current reported data and streamline its display to avoid consumer confusion over multiple sets of similar data

“Reaching across Arizona to provide comprehensive quality health care for those in need” First Steps  Our first step is to engage hospitals in this discussion since some of the Legislative issues were specific to hospital transparency  We will also be having separate conversations with AHCCCS health plans and other relevant stakeholders  After we have made progress on issues related to hospital transparency, AHCCCS and ADHS will begin looking at transparency issues related to other providers

“Reaching across Arizona to provide comprehensive quality health care for those in need” Healthcare Financial Management Association Price Transparency Task Force  Task force members consisted of people representing patients, providers, payers, and employers  Engaged in candid discussions to increase transparency with the health care system

“Reaching across Arizona to provide comprehensive quality health care for those in need” HFMA Price Transparency Task Force guiding principles  Price transparency should empower patients and other care purchasers to make meaningful price and value comparisons prior to receiving care  Any form of price transparency should be easy to use and easy to communicate to stakeholders  Price transparency information should be paired with other information that defines the value of services for the care purchaser  Price transparency should ultimately provide patients with the information they need to understand the total price of their care and what is included in that price  Price transparency will require the commitment and active participation of all stakeholders

“Reaching across Arizona to provide comprehensive quality health care for those in need” HFMA Price Transparency Task Force Recommendations  Providers should serve as the principle source of price information for uninsured and out-of-network patients  Providers should develop price transparency frameworks for uninsured patients and out-of-network patients that reflect several basic considerations such as the limitations of the estimate, the exclusions, and other relevant information such as quality  Referring clinicians should help patients make informed decisions about treatment plans that best fit the patient’s individual situation

“Reaching across Arizona to provide comprehensive quality health care for those in need” HFMA Price Transparency Task Force State website Recommendations  Enable patients to make meaningful price comparisons among providers prior to receiving care  Be easy for patients to access and use  Experiment with the most effective means of communicating price information to patients  Pair price information with other information comprising a range of factors (e.g., patient satisfaction and experience, provider compliance with clinical standards and evidence based medicine, patient safety, and clinical outcomes)  Emphasize, to the extent data are available, the average amount paid for services instead of the average amount charged  Conform with the U.S. Department of Justice and Federal Trade Commission’s Statements of Antitrust Enforcement Policy in Health Care