Online Price Transparency Tool Benefits Patient Ambulatory Costs

Albert Chan, MD, MS

A cost estimation tool can provide accurate real-time estimates of ambulatory procedures when integrated into the online patient portal, according to new study findings.

A team of California-based investigators from Sutter Health and the Stanford Center for Biomedical Informatics Researchers sought to assess the accuracy and user experience of an online cost estimation tool, which is accessible through a patient portal and informed by real-time data feeds from third-party payers. Their findings showed the tool had an accuracy rate of 83.9%, with strong grades for patient satisfaction as well.

Albert Chan, MD, MS, an investigator from Sutter Health, told MD Magazine® that price transparency is a key interest to Sutter Health’s patients. He and his team wanted to understand how the tool would impact patients and clinicians alike.

Due to increased enrollment in high-deductible health insurance plans and mandates from the Patient Protection and Affordable Care Act, individualized price transparency tools have become necessary for patients, investigators noted.

Sutter Health created the Consumer Accessible Fee Estimation initiative to provide price transparency for patients. The cost estimator includes 220 common services from Sutter Health’s top 10 insurance payers by volume. Patients can search for services by keywords, Current Procedural Terminology, or by choosing from a list within categories—immunizations and vaccines, laboratory tests, heart or lung tests, office visits, specialist consultations, and imaging services.

Chan and colleagues designed a 16-question, self-administered survey to better understand patient experience for usability, satisfaction, loyalty, and suggestions for improvement. The survey was completed by Sutter Health patients aged 18 years or older who had matching explanation of benefits statements from August 21, 2018—April 9, 2019.

At the end of April 2019, 4610 estimates were produced using the cost estimator tool. Nearly 3600 estimates (77.4%) were initiated online by patient self-service queries on My Health Online—Sutter Health’s patient portal—1041 estimates (22.6%) were created after queries to the Sutter Health Patient Telephone Service Center.

Of the total estimates, 7.5% of the individuals had a matching explanation of benefits. Fewer than 10% of patients with an explanation of benefits called the Sutter Health Patient Telephone Service Center with concerns about the difference between the estimates from the cost estimator tool and the subsequent bill statement.

The additional 83.9% of patients had equal or less payer responsibility as the price estimated by the cost estimator tool.

More than 90% of patients had private preferred provider organization insurance coverage. A majority of patients (68%) used the tool to search for imaging services, while 20% were for laboratory testing. Using the tool helped patients anticipate costs, according to 42.4% of participants.

Patients who used the digital tool reported positive feedback. Nearly 80% found the tool easy or very easy to use, 87.2% would use the tool again, and 80% would recommend it to others. If a patient had inaccurate estimates, they were more likely to be neutral about the helpfulness of the tool for planning their healthcare needs than those who had accurate estimates (7 participants [31.8%] vs 10 participants [9.7%]; P = .007).

The findings suggest price transparency won’t discourage patients from receiving healthcare services. Investigators noted opportunities to further improve the quality of fee estimates exist, including for the reduction of the variation of data sent by payers, access to more procedures, and improved timeliness of data updates to inform estimates.

Other health systems could partner with healthcare insurance companies to implement a tool like this, they concluded.

The study, “Assessment of Accuracy and Usability of a Fee Estimator for Ambulatory Care in an Integrated Health Care Delivery Network,” was published online in JAMA Network Open.