“As calls to improve upon the foundation of hospital price transparency appear to be ignored and as price disclosure appears to be eroding, we believe that even the limited insights that these files present are a good indication that broader and more comprehensive price disclosure across the healthcare and insurance delivery systems are a good thing for purchasers.”
Time and change will surely show…Loyal 46brooklyn readers know by now that we have a deep fascination with the pricing of goods and services within our healthcare delivery system. Much of that focus has been on prescription drugs, where we have years of experience unraveling riddles. While we have been pleased to see some of what we’ve been teaching make its way into the broader public discourse as of late (details pending, of course), our institutional knowledge has been foundationally built on access to data.
There is no doubt in our mind, that access to publicly available data can have a profound impact on reshaping the way we buy medicines for the better. We know from experience in our own home state of Ohio.
So as data nerds at heart, you could imagine our glee when new federal laws and rules began requiring more public disclosure of prices within the hospital marketplace, providing new unprecedented views of costs within the medical sector.
While we have been dabbling into small analyses of these hospital chargemaster files over the last few months, we came across some local news that made our our new hobby far more relevant: Anthem’s contractual spat with Ohio State University.
As is typical in these contractual negotiations that spill over into the public view, there is the expected finger pointing with both sides laying out their justifications for the impasse, but for us, this is no ordinary quarrel, as members of our team are both insured by Anthem and patients within the OSU health system.
So in evaluating the squabble and realizing that now-publicly-available data could give us insights into it, we began downloading chargemaster files from THE Ohio State University Wexner Medical Center and the OSU James Cancer Center.
While hospital chargemaster files have limitations and deficiencies to be sure, what we found in today’s newest 46brooklyn report was incredibly illuminating. The files show that: Among Anthem’s different individual plans, 99.9% of the time, Anthem’s own plans didn’t always agree on the same price for the same service at OSUWMC When examining the various minimum and maximum prices for effectively all services across all health plans that service OSU, Anthem was almost never the worst payer and almost always had the possibility of being the best payer In comparing Anthem’s prices to OSU’s own affiliated health plan, Anthem’s lowest price is effectively always higher than OSU Health Plan’s lowest plan price, and similarly, Anthem’s highest price is always higher than OSU Health Plan’s maximum price Now, to be clear, this analysis doesn’t tell us that Anthem is right and OSU is wrong in the contract negotiations taking place. Obviously, this is a look at past data, and we have no way of knowing what either side is proposing in their new prospective arrangement. Further, even just focusing on these above numbers, there are a lot of factors and limitations of OSU chargemaster data that we do not know about, including the ever-elusive aggregate discount taken after all line-item services are added together. So while we think the above results is interesting, we do not think it’s the full story, given the limitations that exist within hospital chargemaster data and our approach to develop a comparison price.
However, these insights are highly relevant regardless and demonstrate the incredible usefulness and importance of greater disclosure of pricing realities across our healthcare and insurance delivery system.
As calls to improve upon the foundation of hospital price transparency appear to be ignored and as price disclosure appears to be eroding, we believe that even the limited insights that these files present are a good indication that broader and more comprehensive price disclosure across the healthcare and insurance delivery systems are a good thing for purchasers.
Regardless, today’s report will not be our last foray into hospital pricing data by any stretch, as we anticipate much more in 2025 and beyond. CHECK OUT OUR REPORT For those emailing us about last month’s Wall Street Journal feature from Jared Hopkins and Josh Ulick that dove into the abyss that is Medicare Part D, don’t forget to check out last week’s Medicare pricing report digs into the wide pricing disparities of brand drugs – specifically those first 10 chosen for Medicare price negotiation under the Inflation Reduction Act.
When you’re done with that report, you can review our new 46brooklyn Medicare Differential Drug Pricing Experience Tracker so that you can review all the data for yourself.
SOURCE: https://www.46brooklyn.com/news/anthem-vs-osu-hospital-price-transparency-files-reveal-the-stakes-in-the-fight-between-two-healthcare-giants-ajfh37
