PREVIOUS PATH INITIATIVES SB900 and Out-of-Pocket Expenses

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1 PREVIOUS PATH INITIATIVES SB900 and Out-of-Pocket Expenses

2 4/26/ OAHHS BOARD APPROVES 3-PART PLAN Goal: Move from an F towards an A on the Catalyst for Payment Reform report card. 1) Advocate for a state-sponsored website to display median prices paid by commercial payer for common inpatient and outpatient procedures. 2) Pursue model to advance greater disclosure of out-of-pocket responsibility for insured, and other HFMA recommendations. 3) Hospitals agree to provide, upon request, good faith estimates for self pay and out-of-network patients.

3 4/26/ PART 1: STATE-SPONSORED WEBSITE Passage of SB900 Data will go live no later than July 1 OAHHS to add SB900 data to our existing transparency site Received sample of data architecture from OHA Working with our developers

4 4/26/ PART 2: OUT-OF-POCKET EXPENSES Working with OHLC on initiatives Site will launch early next week Campaign goal: raise awareness, educate and drive traffic to website Target audiences: providers, employers and consumers Will be linked to our own good-faith estimates work if people are out of network or do not have insurance

5 Key site features Simple message and easy to navigate. Welcome! This site will help you get the direct contact information for an out-of-pocket estimate from participating Oregon Health Insurers.

6 Simple directions The insurers listed here have committed to providing out-ofpocket estimates for medical treatments. Click the logo for your health insurer, below, to learn more. Make sure you have your insurance card with you.

7 Consistent information from plans PC and mobile compatible. Users choice of insurer will pop up url and customer service information.

8 Users covered by non-participating insurers will be prompted to refer to their insurance card. Other plans

9 OregonHospitalGuide.org Simple site -- searchable by zip code or hospital. Offers consumers contact information for every hospital for cost estimates. Hospitals give uninsured/out-ofnetwork consumers cost estimates within 3 business days.

10 PART 3: HOSPITAL GOOD-FAITH EST. PATIENT FRIENDLY BILLING

11 4/26/ STANDARDS 1. Good faith estimates are provided to self-pay and out-of-network patients upon request for all scheduled services excluding lab or radiology 2. Estimates include all applicable disclaimers including at minimum i. Reference to the fact that some services may not be included in the estimate, ii. iii. Notice of the potential for out-of-network charges, and Reliance on the accuracy of stated benefits 3. Based on the applicability of financial assistance, the availability of financial assistance and location of financial assistance information on the hospital s website is communicated to patients at the time of the estimate 4. Estimates are provided within three business days of receiving all applicable information

12 4/26/ IMPLEMENTATION TIMELINE June 2015 Summer/ Fall Development of resources By Dec. 31 Hospitals fully implement Tier 1 standards Q Secret Shopper of hospitals to evaluate level of implementation Member rollout webcast April 2015 Final review by the Board Transition to Implementation

13 4/26/ SECRET SHOPPER Purpose: To assess how hospital s signed commitment reflects the experience of an anonymous caller seeking a good faith estimate. Set-up & Structure: Caller Profile Patient Profile Called main hospital line Provided info for estimate, but asked no leading questions. Every hospital was called once

14 4/26/ Was an estimate provided to a self-pay or out of network patient upon request? No 3% Met Tier 1 standard 97% Yes, but 3% No 3% Met Tier 1 standard 94% Was an estimate provided within 3 business days?

15 4/26/ Disclaimer: Reference to the fact that some services may not be included in the estimate Met Tier 1 standard 40% No 33% Yes, but 27% Met Tier 1 standard 38% Yes, but 12% No 50% Disclaimer: Reliance on the accuracy of stated benefits Disclaimer: Notice of potential for out-of-network charges Met Tier 1 standard 41% Yes, but 18% No 41%

16 4/26/ Yes, but 3% Was it communicated that financial assistance is available? Met Tier 1 standard 29% No 68% Met Tier 1 standard 15% Yes, but 3% No 82% Was it communicated how to obtain more information on financial assistance?

17 4/26/ COMMON THEMES Strengths: (Almost) all hospitals were able to provide a good faith estimate, and within 3 days. Standards met! When disclaimer language was given, it was straightforward and complete. Of the 5 hospitals who communicated how to obtain more info on financial assistance, they clearly directed me to the location on the website.

18 4/26/ COMMON THEMES Opportunities for improvement: Main line operator often did not know where to transfer me to Usually transferred to the right location on the first attempt Often did not know where I was being transferred Disclaimer language was often implicit Little to no mention of the availability of financial assistance or possible discounts. No significant difference between stand alone hospitals and systems.

19 4/26/ GFE PROGRESS April: May: Presented to PATH work group Reports sent to hospitals April 29: Presentation to OAHHS Board OHLC website & Oregon Hospital Guide pages go live May 11: Webcast to members walking through outcomes of Secret Shopper May 18: HFMA presentation 2016/ 2017: More member education? Secret Shopper redux