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AHIMA’s Position

AHIMA supports the use of public policy to ensure that individuals have all the information they need to make informed choices about their healthcare. This includes both access to their personal health information and actionable information about the costs of their healthcare. Health information (HI) professionals have extensive knowledge and expertise to contribute to developing policies to enhance affordability and health information.

While the affordability of healthcare affects many entities, including employers, governments, and health plans, AHIMA is focused on policies to enhance affordability for individuals. To support individuals in making informed decisions about their healthcare, AHIMA believes that public policy must:

  1. Support individuals in accessing both their personal health information and actionable information about the costs of their healthcare.
  2. Support the development of accurate, useful, real-time tools to inform individuals of their healthcare costs.
  3. Find equitable solutions to prevent “surprise billing” for consumers.
  4. Maintain the privacy and security of health information, including when it is shared with third parties.
  5. Support education for consumers, regardless of their financial situation, on how to understand their health plan coverage and ask for the information they need to make informed decisions.

 

Background

Trends in health spending. According to the federal government, health spending in 2019 was $3.8 trillion, or $11,582 per person. Spending is projected to continue growing faster than the economy as a whole over the next decade, accounting for almost 20 percent of Gross Domestic Product in 2028.

 

Trends in affordability. Most people have health coverage through either an employer or a public program, such as Medicare and Medicaid. However, in 2019, 28.9 million individuals were uninsured. In addition, as healthcare costs have risen, many employers have passed along increases to individuals through higher premiums, deductibles, and other forms of cost-sharing.

According to the Kaiser Family Foundation, the average deductible for those with employer-based insurance for a single employee has increased 25 percent over the last five years and 79 percent over the last ten years.  Recent years have also seen an increase in high-deductible health plans. According to a recent survey, roughly half of US adults have delayed or avoided care because of cost.

 

Calls for transparency. As out-of-pocket costs have increased over time, policymakers have increasingly called for transparency in healthcare costs and health plan coverage. The Affordable Care Act of 2009 included the first requirement for hospitals to make available their list of standard charges for items and services. More recently, President Trump issued an Executive Order in June 2019 on “Improving Price and Quality Transparency in American Healthcare to Put Patients First.”

 

Growth in pricing tools. Similar to advances in the travel industry or retail shopping, technology tools have emerged to help consumers better understand healthcare prices. These tools include, for example, state hospital price comparison tools, websites, and apps that bring together price and quality information for individuals and entities that focus on a particular healthcare sector, such as prescription drugs.

For a comparison of some of these tools, see: Healthcare Transparency. However, consumer use of these tools is still limited. Recent policies that require posting price and coverage information in machine-readable formats could fuel development of more accurate and personalized pricing tools.

Key Points

As healthcare moves toward better information to support affordability, certain barriers and challenges must be addressed:

  • Healthcare is complex, and not all situations allow consumers to “shop” for care. This is not only true for emergency care, but complexity can also make it hard to understand the costs of treating advanced illnesses or unexpected complications. Experts estimate that less than half of healthcare services can be considered “shoppable,” meaning that they are common healthcare services that can be researched in advance.6 Healthcare items, such as prescription drugs and medical devices, are more amenable to shopping.
  • Health plan coverage and billing rules can change over time, resulting in changes in out-of-pocket costs or prior authorization rules that may take consumers by surprise.
  • Understanding out-of-pocket costs can be hard. Healthcare providers maintain contracts with many different payers, and each payer may offer a range of health plans with varied deductibles and other cost-sharing arrangements.
  • As we increase the use of technology to inform consumers, some people may have health conditions or personal preferences that require other forms of communication, including paper documents or phone calls. In addition, access to broadband continues to be challenging for some individuals in both rural and urban areas.

 

Want to read the full statement or share it with your colleagues?

Related Content

January 5, 2021

AHIMA Calls for Biden Administration and Congress to Ensure Health Information is at Forefront of Health Policy

AHIMA calls for the incoming administration to consider the implications of health information as they begin to implement new health policies in 2021.

 

January 4, 2021

AHIMA's 2020 Policy Statements

In this episode of HI Pitch, Lauren Riplinger, AHIMA's vice president of advocacy, public policy and government affairs, reviews the seven policy statements released by AHIMA in 2020.

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