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Thank you for your participation in America's Health Insurance Plans (AHIP) Survey on Price Transparency.


Please answer all the survey questions based on the price transparency tools you offer IN THE COMMERCIAL MARKET, for both fully insured and self-insured products. Price transparency tools aimed at Medicaid and Medicare Advantage beneficiaries are outside the scope of this survey.

Please respond on behalf of all of your subsidiary plans, if applicable. If you would like to submit separate responses for your subsidiaries, please forward the survey link to appropriate staff and they will be able to submit a separate survey response.

 
 
 
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If you have any questions about the survey or technical difficulties with your response, please contact German Veselovskiy at [email protected] or 202-778-8476.
 
 
 
Section I. Contact Information and Plan Characteristics
 
 
1. Please provide your contact information.
 
 
* Name
   
 
 
* Title
   
 
 
* Company
   
 
 
* Phone
   
 
 
* Email Address
   
 
 
 
* 2A. What is your total fully insured commercial enrollment as of the end of September, 2013?
   
 
 
* 2B. What is your total self-insured commercial enrollment as the end of September, 2013?
   
 
 
 
* 3.What commercial markets do you service (please check all that apply)?
 
Fully insured individual market
 
Fully insured large group market (50+ employees)
 
Fully insured small group market (< 50 employees)
 
Self-insured (ERISA)

 
 
 
Section II. Price Estimator Tools Questions
 
 
Definitions:

Price Estimator tools: For the purposes of this survey, by “price estimator tools” we mean tools that allow consumers to obtain estimates of prices associated with specific health care services that could be either provider-specific or based on geography.

Provider: In this survey we use the term health care provider to denote a healthcare professional (e.g., doctor, nurse) or facility (e.g., hospital, clinic) that delivers health care services.


Please respond to the survey based on price estimator tools you offer in the commercial market.
 
 
 
* 4. Do your health plan members currently have access to price estimator tools?
 
Yes, they only have access to price estimator tools provided by our health plan
 
Yes, they only have access to third party price estimator tools (e.g., Castlight, Optum, Truven)
 
Yes, some members have access to the health plan-provided tool and some members have access to third-party price estimator tools
 
No, our members currently do not have access to any price estimator tools
 
 
 
* 5. Please estimate what percentage of your commercial enrollees have access to third-party price estimator tools as of the end of September, 2013?
   
 
 
 
In this survey we use the term health care provider to denote a healthcare professional (e.g., doctor, nurse) or facility (e.g., hospital, clinic) that delivers health care services.
 
 
 
* 6. Do you supply your provider pricing or adjudicated claims data to third-party vendors (e.g., Castlight, Optum, Truven)?
 
Yes
 
No
 
 
 
In this survey we use the term health care provider to denote a healthcare professional (e.g., doctor, nurse) or facility (e.g., hospital, clinic) that delivers health care services.

 
 
 
* 6. Do you supply your provider pricing or adjudicated claims data to third-party vendors (e.g., Castlight, Optum, Truven)?
 
Yes
 
No
 
 
 
* 7. For which populations do you supply provider pricing data (either adjudicated claims data or negotiated rates)?
 
For specific employer accounts
 
For a broad population of our members
 
Other
 
 
 
 
* 8. Do you plan to offer a price estimator tool in the future?
 
Yes, in the next 1-5 months
 
Yes, in the next 6-12 months
 
Yes, in the next 13-24 months
 
Yes, greater than 24 months
 
No
 
 
 
Now, please tell us more about the price estimator tool(s) provided by your health plan.
 
 
 
In this survey we use the term health care provider to denote a healthcare professional (e.g., doctor, nurse) or facility (e.g., hospital, clinic) that delivers health care services.
 
 
9. What capabilities are included in your price estimator tool(s) (please check all that apply)? Please respond to this question based on all tools you currently offer.
Available to non-members (no member ID or log-in required) Available only to members (member ID or log-in required) This capability is not offered
* Provider comparison-shopping for health care services
* Estimating price of prescription drugs
* Estimating price of dental services
 
 
If other capabilities, not listed above, are included, please describe them:
   
 
 
10. What characteristics are taken into account in your price estimator tool(s) (please check all that apply, based on all price estimator tools that you currently offer)?
Provider comparison-shopping for health care services Estimating price of prescription drugs Estimating price of dental services Characteristic is not taken into account
* Product type (e.g., HMO, PPO etc.)
* Plan benefit design (e.g., deductibles, coinsurance etc.)
* Member risk factors (e.g., tobacco use, chronic conditions etc.)
* Zip code
 
 
If other characteristics, not listed above, are taken into account, please describe them:
   
 
 
 
For the remainder of the survey:


Please answer the following questions based on the price estimator tool available only to your members (member ID or log-in required).


If you offer several member-only price estimator tools please respond based on the tool accessible to the largest number of your commercial members.
 
 
 
* 11. When did you begin offering the price estimator tool to your members?
 
Less than a year ago.
 
1-3 years ago.
 
4-5 years ago.
 
More than 5 years ago
 
 
 
* 12. For which health care services can your members obtain price estimates (please check all that apply)?
 
Outpatient services provided at urgent care centers
 
Elective outpatient surgery/procedures
 
Delivery and postpartum care
 
Inpatient surgical services
 
Physician services
 
Inpatient non-surgical services
 
Services for select chronic conditions (such as HbA1c testing for diabetes etc.)
 
Telemedicine vs. in-person visits
 
Prenatal care
 
Services provided in ER departments
 
Radiology services (e.g., X-rays, CT-scans etc.)
 
Services at retail or convenience clinics
 
Outpatient laboratory services
 
Prescription drugs – generic, preferred brands, non-preferred brands
 
Other services (please specify) :
 

 
 
 
* 13. How do you choose which services to include in your price estimator tool? (please check all that apply)?
 
Based on employer requests
 
Services with variability in quality
 
Based on market research
 
Services with high variability in cost
 
Based on member needs/feedback
 
Based on provider needs/feedback
 
Most commonly (high frequency of use) used procedures/services
 
Other (please specify) :
 

 
 
 
In this survey we use the term health care provider to denote a healthcare professional (e.g., doctor, nurse) or facility (e.g., hospital, clinic) that delivers health care services.

 
 
14. What elements are displayed in your price estimator tool? (please check all that apply)
Based on in-network provider prices Based on out-of-network service-level estimates We do not provide this information
* Co-insurance, for which the member is responsible
* Deductible, for which the member is responsible
* Copays (including differential copays for tiered networks)
* Out-of-pocket maximum limits
* Current balance on deductible relative to the member’s out-of-pocket limit
* HSA account balances (where applicable)
* Links to the third-party HSA administrator
* Episode of care costs (e.g., facility costs, physician fees, costs of durable medical equipment, etc.): all costs associated with a defined episode of care
* Reference-based pricing for select services (where applicable)
* Estimates for treatment cost at the individual provider level
* Comparison of prices for specific services across individual providers
 
 
If other elements, not listed above, are displayed, please describe them:
   
 
 
15. What metrics are made available through your price estimator tool?
Yes, we make this metric available for services from in-network providers Yes, we make this metric available for services from out-of-network providers No, we do not make this metric available
* Average costs for a specific geographic area
* Median costs for a specific geographic area
* Range of costs for a specific geographic area (e.g., range of costs for the 25th-75th percentile of claims for a particular service or procedure etc.)
* Average costs at the provider level
* Median costs at the provider level
* Range of costs at the provider level (e.g., range of costs for the 25th-75th percentile of claims for a particular service or procedure etc.)
* Estimate based on the actual negotiated rate
 
 
If you make other metrics available through your price estimator tool, please describe them:
   
 
 
 
* 16. What data do you use to generate estimates in your price estimator tool (please check all that apply)?
 
Your plan’s current negotiated rates for specific providers
 
Publicly available claims data for a specific geographic area
 
Publicly available claims data for a specific provider
 
Your plan's historical claims data for a specific geographic area
 
Your plan’s historical allowed rates for specific providers
 
Other (please specify) :
 

 
 
 
* 17. How often do you update the data used in your price estimator tool?
 
Real-time updates
 
Bimonthly (twice a month)
 
Monthly
 
Quarterly
 
Semiannually
 
Annually
 
Do not know
 
Other (please specify) :
 
 
 
18. What other types of provider information do you make available to your members (please check all that apply)?
Yes, we make this information available and it is integrated in our price estimator tool Yes, we make this information available but it is not integrated in our price estimator tool No, we do not make this information available
* Geographic location of providers
* Board certification
* Information on listed providers accepting new patients
* Provider performance data (clinical quality, safety etc.)
* Patient experience reviews (e.g., reviews of a doctor by patients)
* Centers of Excellence
 
 
If you make other types of information available, please describe them:
   
 
 
 
* 19. What medium do you use to deliver the price estimates to your members (please check all that apply)?
 
Call center
 
Web-based tool
 
Paper copy
 
Mobile apps (e.g., widget)
 
Other media (please specify)
 

 
 
 
* 20. How do you direct members to your price estimator tool (please check all that apply)?
 
TV/radio advertisement
 
E-mail (e.g., e-newsletters, personal correspondence, etc.)
 
Messaging on the health plan's portal
 
Social media (e.g., Twitter feed or Facebook posts)
 
Phone outreach by customer service (inbound and outbound)
 
Text messages
 
Outreach through providers
 
Outreach through employers
 
Postal mail (e.g., targeted marketing, member newsletters, etc.)
 
Phone outreach by nurse care manager
 
Other (please specify) :
 

 
 
 
* 21. What kind of training or assistance do you offer your members in the use of your price estimator tool (please check all that apply)?
 
We do not offer training assistance in use of our price estimator tool
 
Brochures
 
Assistance by nurse care managers
 
Web-based training (e.g., online chats, videos)
 
Assistance through customer service
 
Other assistance (please specify) :
 

 
 
 
* 22. Does your price estimator tool incorporate specific features making it more accessible for certain subpopulations (please check all that apply)?
 
Yes, for visually impaired members
 
Yes, for members with low health literacy
 
Yes, for members with limited English proficiency
 
Yes, for other subpopulations
 
 
No

 
 
 
23. Please describe the features of your price estimator tool that make it more accessible for certain subpopulations:
   
 
 
 
* 24. Do you measure use of your price estimator tool by members?
 
Yes
 
No
 
 
25. What percent of your commercial enrollees are registered users of your web site as of the end of September, 2013 (i.e. have an account)?
Web site users, %
-
 
 
26. Please estimate the percentage of your registered web site users who are also using the price estimator tool as of the end of September, 2013.
Price estimator tool users, %
-
 
 
 
* 27. How do you measure members’ use of your price estimator tool (please check all that apply)?
 
Average length of time spent on the estimator tool
 
Number of hits to the website
 
Number of repeat hits to the website
 
Number of unique users
 
Percentage of users’ start and/or completion of price calculations
 
Other (please specify) :
 

 
 
 
* 28. Please describe the key characteristics of your members who are frequent users of your price estimator tool (e.g., " females with chronic conditions", "members residing in the Northeast", "CDHP members" etc.).
   
 
 
 
* 29. In your experience, what features of your price estimator tool have proved to be most useful to members (check all that apply)?
 
Ability to compare prices for services across providers
 
Estimates for a wide range of services
 
Estimates for member-specific out-of-pocket costs based on benefits
 
Ability to concurrently compare providers on quality and price
 
Ability to access the price estimator tool by various means (e.g., mobile apps etc.)
 
Real-time support and guidance for use of price estimator (e.g., customer support, chats etc.)
 
Do not know
 
Other features
 

 
 
 
* 30. Are your members offered incentives to use your price estimator tool?
 
Yes, we currently offer incentives
 
No, but we plan to offer incentives in the future
 
No, and we do not have plans to offer incentives in the future
 
 
 
* 31. What types of member incentives do you offer for use of price estimator tools (check all that apply)?
 
Merchandise or gift cards
 
Cash payment or bonus
 
Other :
 

 
 
 
* 32. Please describe to what activities you tie these incentives (e.g., previewing the tool, etc.)
   
 
 
 
* 33. What quantifiable outcomes have you observed as a result of members using the price estimator tool (please check all that apply)?
 
Increased member use of in-network providers
 
Increased member use of lower-cost providers
 
Increased member use of providers/hospitals that ranked high on safety or quality of care measures
 
Shifts in sites of care
 
Member out-of-pocket cost savings
 
Employer cost savings
 
No change observed
 
Unable to quantify
 
We have not yet conducted an evaluation, but are planning to assess impact of the tool in the future
 
Other outcomes :
 

 
 
 
* 34. What challenges have you encountered in providing the price estimator tool to members (check all that apply)?
 
Restrictions on data sharing due to “gag clauses” in contracts with providers
 
Complying with the regulatory requirements (federal or state)
 
Limited member uptake
 
Lack of reliable or incomplete data
 
Lack of member awareness about the tool
 
Unrealistic member expectations regarding the precision of the cost estimates
 
Translating data into consumer-friendly information
 
Infrastructure costs
 
No challenges experienced
 
Other challenges (please specify):
 

 
 
 
35. How have you addressed these challenges (if you chose in the previous question the following option: "No challenges experienced" you can skip this question)?
   
 
 
 
36. What changes, if any, do you plan to make to your plan estimator tool in the future?
 
Add estimates for services delivered by out-of-network providers
 
Add estimates for additional services/conditions
 
Other
 

 
 
 
In this survey we use the term health care provider to denote a healthcare professional (e.g., doctor, nurse) or facility (e.g., hospital, clinic) that delivers health care services.
 
 
9. What capabilities are included in the third-party price estimator tool(s) offered to your members (please check all that apply)? Please respond to this question based on all tools they are currently offered.
Available to non-members (no member ID or log-in required) Available to members (member ID or log-in required) This capability is not offered
* Provider comparison-shopping for health care services
* Estimating price of prescription drugs
* Estimating price of dental services
 
 
If other capabilities, not listed above, are included, please describe them:
   
 
 
10. What characteristics are taken into account in the third-party price estimator tool(s) offered to your members (please check all that apply, based on all the price estimator tools that you currently offer)?
Provider comparison-shopping for health care services Estimating price of prescription drugs Estimating price of dental services Characteristic is not taken into account
* Product type (e.g., HMO, PPO etc.)
* Plan benefit design (e.g., deductibles, coinsurance etc.)
* Member risk factors (e.g., tobacco use, chronic conditions etc.)
* Zip code
 
 
If other characteristics, not listed above, are taken into account, please describe them:
   
 
 
 
* 11. When did you begin offering the third-party price estimator tool to your members?
 
Less than a year ago.
 
1-3 years ago.
 
4-5 years ago.
 
More than 5 years ago
 
 
 
* 12. For which health care services can your members obtain price estimates (please check all that apply)?
 
Outpatient laboratory services
 
Outpatient hospital services (surgical and non-surgical)
 
Prenatal care
 
Telemedicine vs. in-person visits
 
Prescription drugs – generic, preferred brands, non-preferred brands
 
Services for select chronic conditions (such as HbA1c testing for diabetes etc.)
 
Physician services
 
Services provided at the ER departments
 
Elective outpatient surgery/procedures
 
Radiology services (e.g., X-rays, CT-scans etc.)
 
Services provided at urgent care centers
 
Services at retail or convenience clinics
 
Delivery and postpartum care
 
Inpatient non-surgical services
 
Inpatient surgical services
 
Other services(please specify) :
 

 
 
 
* 13. How do you choose which services to include in the third-party price estimator tool offered to your members? (please check all that apply)?
 
Determined by a third-party vendor
 
Most commonly (high frequency of use) used procedures/services
 
Based on member needs/feedback
 
Services with high variability in cost
 
Based on market research
 
Based on provider needs/feedback
 
Services with variability in quality
 
Based on employer requests
 
Other (please specify) :
 

 
 
 
In this survey we use the term health care provider to denote a healthcare professional (e.g., doctor, nurse) or facility (e.g., hospital, clinic) that delivers health care services.
 
 
14. What elements are displayed in the third-party price estimator tool offered to your members? (please check all that apply)
Based on in-network provider prices Based on out-of-network service-level estimates The tool does not provide this information
* Co-insurance, for which the member is responsible
* Deductible, for which the member is responsible
* Copays (including differential copays for tiered networks)
* Out-of-pocket maximum limits
* Current balance on deductible relative to the member’s out-of-pocket limit
* HSA account balances (where applicable)
* Links to the third-party HSA administrator
* Episode of care costs (e.g., facility costs, physician fees, costs of durable medical equipment, etc.): all costs associated with a defined episode of care
* Reference-based pricing for select services (where applicable)
* Estimates for treatment cost at the individual provider level
* Comparison of prices for specific services across individual providers
 
 
If other elements, not listed above, are displayed, please describe them:
   
 
 
15. What metrics are included in the third-party price estimator tool offered to your members?
Yes, we make this metric available for services from in-network providers Yes, we make this metric available for services from out-of-network providers No, we do not make this metric available
* Average costs for a specific geographic area
* Median costs for a specific geographic area
* Range of costs for a specific geographic area (e.g., range of costs for the 25th-75th percentile of claims for a particular service or procedure etc.)
* Average costs at the provider level
* Median costs at the provider level
* Range of costs at the provider level (e.g., range of costs for the 25th-75th percentile of claims for a particular service or procedure etc.)
* Estimate based on the actual negotiated rate
 
 
If there are other metrics available through the third-party price estimator tool offered to your members please describe them:
   
 
 
16. What other types of provider information do you make available to your members (Please check all that apply)?
Yes, we make this information available and it is integrated in the price estimator tool Yes, we make this information available but it is not integrated in the price estimator tool No, we do not make this information available
* Geographic location of providers
* Board certification
* Information on listed providers accepting new patients
* Provider performance data (clinical quality, safety etc.)
* Patient experience reviews (e.g., reviews of a doctor by patients)
* Centers of Excellence
 
 
If your make available other types of information, not listed above, please describe them:
   
 
 
 
* 17. What data are used to generate estimates in the third-party price estimator tool offered to your members(please check all that apply)?
 
Your plan’s current negotiated rates for specific providers
 
Determined by a third-party vendor
 
Publicly available claims data for a specific geographic area
 
Your plan’s historical allowed rates for specific providers
 
Publicly available claims data for a specific provider
 
Other (please specify) :
 

 
 
 
* 18. How often are the data updated in the third-party price estimator tool offered to your members?
 
Real-time updates
 
Bimonthly (twice a month)
 
Monthly
 
Quarterly
 
Semiannually
 
Annually
 
Do not know
 
Other (please specify) :
 
 
 
 
* 19. What media are used to deliver the price estimates to your members (please check all that apply)?
 
Mobile apps (e.g., widget)
 
Paper copy
 
Call center
 
Web-based tool
 
Other media (please specify)
 

 
 
 
* 20. How do you direct members to the third-party price estimator tool (please check all that apply)?
 
E-mail (e.g., e-newsletters, personal correspondence, etc.)
 
Phone outreach by customer service (inbound and outbound)
 
Outreach through employers
 
Messaging on the health plan's portal
 
Postal mail (e.g., targeted marketing, member newsletters, etc.)
 
Outreach through providers
 
TV/radio advertisement
 
Social media (e.g., Twitter feed or Facebook posts)
 
Text messages
 
Phone outreach by nurse care manager
 
Other medium (please specify) :
 

 
 
 
* 21. What kind of training or assistance is offered to your members in the use of the third-party price estimator tool (please check all that apply)?
 
Web-based training (e.g., online chats, videos)
 
Assistance through customer service
 
Brochures
 
Assistance by nurse care managers
 
We do not offer training assistance in use of the price estimator
 
Other (please specify) :
 

 
 
 
* 22. Does the third-party price estimator tool available to your members incorporate specific features making it more accessible for certain subpopulations (please check all that apply)?
 
Yes, for members with low health literacy
 
Yes, for members with limited English proficiency
 
Yes, for visually impaired members
 
Yes, for other subpopulations
 
 
Do not know
 
No

 
 
 
23. Please describe the features of the third-party price estimator tool available to your members that make it more accessible for certain subpopulations
   
 
 
 
* 24. Do you measure use of the third-party price estimator tool by your members?
 
Yes
 
No
 
 
25. What percent of your commercial enrollees use the third-party price estimator tool as of the end of September 2013:
Price estimator tool users, %
-
 
 
 
* 26. How is member use of the third-party price estimator tool measured (please check all that apply)?
 
Average length of time spent on the estimator tool
 
Number of hits to the website
 
Number of repeat hits to the website
 
Number of unique users
 
Percentage of users’ start and/or completion of price calculations
 
Other (please specify) :
 

 
 
 
* 27. Please describe the key characteristics of your members who are frequent users of the third-party price estimator tool (e.g., " females with chronic conditions", "members residing in the Northeast", "CDHP members" etc.).
   
 
 
 
* 28. In your experience, what features of the third-party price estimator tool have proved to be most useful to members (check all that apply)?
 
Ability to compare prices for services across providers
 
Estimates for a wide range of services
 
Estimates for member-specific out-of-pocket costs based on benefits
 
Ability to concurrently compare providers on quality and price
 
Ability to access the price estimator tool by various means (e.g., mobile apps etc.)
 
Do not know
 
Real-time support and guidance for use of price estimator tool (e.g., customer support, chats etc.)
 
Other features
 

 
 
 
* 29. Are your members offered incentives to use the third-party price estimator tool ?
 
Yes, we currently offer incentives
 
No, but we plan to offer incentives in the future
 
No, and we do not have plans to offer incentives in the future
 
 
 
* 30. What types of member incentives do you offer for use of the third-party price estimator tool (check all that apply)?
 
Merchandise or gift cards
 
Cash payment or bonus
 
Other :
 

 
 
 
* 31. Please describe to what activities you tie these incentives (e.g., previewing the tool etc.)
   
 
 
 
* 32. What quantifiable outcomes have you observed as a result of members using the third-party price estimator tool (please check all that apply)?
 
Increased member use of in-network providers
 
Increased member use of lower-cost providers
 
Increased member use of providers/hospitals that rank high on safety or quality of care measures
 
Shifts in sites of care
 
Member out-of-pocket cost savings
 
Employer cost savings
 
No change observed
 
Unable to quantify
 
We have not yet conducted an evaluation, but are planning to assess impact of the tool in the future
 
Other outcomes :
 

 
 
 
33. What challenges have you encountered in providing the price estimator tool to your members (check all that apply)?
 
Restrictions on data sharing due to “gag clauses” in contracts with providers
 
Complying with the regulatory requirements (federal or state)
 
Limited member uptake
 
Lack of reliable or incomplete data
 
Lack of member awareness about the tool
 
Unrealistic member expectations regarding the precision of the cost estimates
 
Translating data into consumer-friendly information
 
Infrastructure costs
 
No challenges experienced
 
Other challenges (please specify):
 

 
 
 
34. How have you addressed these challenges (if you chose in the previous question the following option: "No challenges experienced" you can skip this question)?
   
 
 
 
35. What changes, if any, do you plan to make to the price estimator tool available to your members in the future?
 
Add estimates for services delivered by out-of-network providers
 
Add estimates for additional services/conditions
 
Other
 

 
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