Spectrum Health, an integrated health system based in Grand Rapids, Mich., has focused on transparency both as a provider of health care, through the Spectrum Health network of hospitals and clinics, and as a payer, through Priority Health, the system's health plan.

Spectrum Health. Spectrum Health has been publishing price information for its Grand Rapids hospitals on the Spectrum Health website since 2006. Price estimates, which are updated annually, are offered for a wide range of common adult procedures—including inpatient and outpatient procedures and childbirth services—and for common diagnostic procedures. For each procedure, Spectrum provides the average estimated price, the average Medicare payment, the average Medicaid payment, and the average insurance payment. 

Uninsured patients are advised of their potential eligibility for Medicaid, Medicare, or other forms of financial assistance as well as payment options offered through Spectrum Health and are encouraged to contact a customer satisfaction/patient billing representative to discuss options. For insured patients, the site provides a list of insurance companies and plans accepted by Spectrum Health as well as contact information for the plan where it is available. For procedures not listed on the website or for additional questions related to pricing, the website provides both phone contact and secure email options to reach a pricing specialist, with the promise of a response by the end of the following business day. A frequently asked question page and glossary of terms provide additional resources for patients.

Throughout the site, Spectrum Health advises patients that the estimated prices do not include physicians' fees for the patient's surgeon, anesthesiologist, or radiologist, and that those fees will be billed separately. To help the patient access pricing information for these services, the website provides contact information for the medical groups that Spectrum Health uses to provide anesthesiology, pathology, and EKG interpretation services. 

Priority Health. Spectrum Health's health plan, Priority Health, has developed a price transparency tool for its members to support three goals: 

  • Engage customers in their healthcare decisions
  • Promote accountability among providers
  • Address the fundamental issue of healthcare costs

Priority Health contracted with Healthcare Bluebook, a company with expertise in developing transparency tools for self-funded employers, to develop the transparency tool for its members. The tool focuses on approximately 200 discretionary (and thus "shoppable") services. Approximately 50 percent of Priority Health members require one or more of these services in a given year, and these services together represent approximately 20 percent of Priority Health's total medical spend.

The transparency tool focuses on variations in contracted rates at the facility level. Color-coded lists of healthcare facilities that offer the desired service use green to indicate those that are at or below a fair price, yellow to indicate those that are slightly above fair price, and red to indicate those that are among the most expensive. The list also identifies facilities that will not disclose prices and advises members to contact them directly for pricing information. 

As of December 2013, 47 percent of healthcare facilities in the Priority Health network had agreed to have their prices disclosed; Priority's goal is to increase this to 75 percent by 2015. 

The tool was initially offered exclusively to members when it went live in August 2013. As of January 2014, Priority Health is also offering access to providers so they can consult more knowledgeably with patients who need a referral to facilities that will offer the desired level of value in terms of quality, patient experience, and price. 

Priority Health will continue to improve the price transparency experience for members by: 

  • Personalizing information for members with cost estimators and benefit summaries
  • Linking the Healthcare Bluebook tool to doctor-search tools and patient education
  • Adding to the discretionary/shoppable procedures included in the tool