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TransUnion Survey: Providers Fall Short of Meeting Growing Patient Demand for Greater Healthcare Cost Transparency

National Survey of Nearly 7,500 Consumers Finds State Healthcare Experiences Differ

CHICAGO, IL -- (Marketwired) -- 06/23/14 -- A TransUnion Healthcare national survey of insured consumers found that two-thirds of Americans report being consistently surprised by their medical bills. This could be due to the fact that, according the survey, only 25% of patients are being offered pre-treatment cost estimates from their providers, despite evidence that demand for such information is growing.

This survey is the fourth in a series of TransUnion Healthcare reports that examine patient billing experiences as the healthcare system is transformed by the Affordable Care Act (ACA) and other market dynamics.

The rise in consumer cost awareness extends beyond out-of-pocket costs such as premiums, co-pays and co-insurance payments. Two-thirds (63%) of survey respondents reported that they wanted to know the full cost of care, including their insurance company's portion, while just one-third (37%) said they only cared about the costs they are directly responsible for paying.

"Today's cost-aware consumer has a greater expectation that providers will offer upfront cost estimates and timely and accurate post-treatment bills. With consumers placing more emphasis on billing and payment when evaluating quality of care, it's imperative that providers have the technology and processes to meet this consumer demand," said Dave Wojczynski, senior vice president of TransUnion Healthcare.

While consumers are seeking out more information about costs, more than half (54%) reported they were either sometimes or always confused by bills and 62% were either sometimes or always surprised by out-of-pocket costs. As a result, Americans are beginning to see the value of front-end cost estimates as a critical tool to improve their ability to manage costs. In fact, the survey found more than 80% of respondents stated that receiving pre-treatment cost estimates and pre-treatment insurance coverage estimates would be either "helpful" or "extremely helpful" in managing medical costs.

"Our survey results shed light on the fact that patients are more attuned to healthcare costs and billing experiences as they take a more active role in evaluating and selecting their healthcare options," said Wojczynski. "Front-end solutions that provide upfront cost estimates, and back-end solutions that deliver accurate bills, will be critical as consumers continue to link their billing experience to quality of care. Accurate, timely and transparent cost information will help improve overall patient satisfaction and will increase return visits to providers."

In addition to helping consumers manage their healthcare costs, cost transparency and upfront cost estimates can help improve overall consumer perception of their quality of care, and as a result, influence consumers' decisions whether to continue using a provider.

  • The survey found that nearly 80%of patients who gave high ratings to their quality of care over the past year also said their billing and payment experiences were usually positive.
  • At the same time, nearly 85% of patients who gave poor ratings for quality of care also gave poor ratings for their billing and payment experiences.

"For the third consecutive year, our survey found a correlation between patients' perception of care quality, and medical cost transparency and billing accuracy," added Wojczynski. "One strategy to improve patient billing experiences is for providers to offer front-end cost estimates."

Survey findings show how much of an impact front-end cost estimates could have on patient experience.

  • More than eight in 10 Americans (84%) reported that front-end cost estimates would have either a somewhat positive (37%) or very positive impact (47%) on their decision to continue using a provider.
  • Patients value upfront cost estimates nearly as much as other clinical factors in their decision making, including outstanding bedside manner (86%); prompt test results (89%); and accurate diagnoses (90%).
  • Despite this strong consumer demand, few survey respondents have received upfront cost estimates over the past year, and even fewer report having received them without asking. Only 12% of Americans found it "very easy" to get cost information before receiving medical care and nearly half of Americans (48%) said it was either "somewhat difficult" (28%) or "very difficult" (20%).

Healthcare Cost and Billing Experiences Differ by State
While TransUnion's surveys have shown a consistent national trend towards greater consumer interest in the details of healthcare costs and growing demand for front-end cost estimates, the results revealed that this trend is moving at different speeds and is driven by different factors in each state.

Patients in the five states that have passed legislation to improve and encourage healthcare cost transparency -- Colorado, Maine, Massachusetts, Vermont, and Virginia -- are no more likely than those in other states to have asked for or received front-end cost estimates.

  • On average, patients in these five states asked for front-end cost estimates at a lower rate (32%) than the overall national rate (37%), and none of the five states were among the top 10 states in which patients reported that it was easy to find the cost information before receiving treatment.

While concerns about costs are increasing nationally, there is a noticeable difference between large and small states.

  • In smaller states, particularly those in the west, the trend is more pronounced. In Colorado, New Mexico, Utah, Idaho, Nevada, and other western and mountain states, more than 60%of consumers reported an increase in concern over healthcare costs.

In many large states -- such as New York, California, Florida, and Texas -- less than 50% of consumers reported an increase in concern over health costs in light of reform implementation. In smaller states, patients were more likely to report that they had poor or mediocre experiences with billing and payment. In fact, in states with a population in the bottom third of the 50 states, poor ratings for billing and payment experience were reported at twice the rate they were in the larger states.

These size-related differences were also apparent in consumers' experiences with front-end cost estimates and the ease of getting pre-treatment information.

  • In larger states, consumers were far more likely to report that it was easy or somewhat easy to find healthcare cost information before receiving treatment.
  • In states with populations in the top third of U.S. states, an average of 35% of respondents reported that it was easy to find pre-treatment cost information, and it was even higher in the largest states, including California (48%) and New York (40%).
  • At the same time, in some of the least populous states -- Vermont, Maine, New Mexico, and Idaho -- less than 20% of consumers reported that it was easy for them to find this information.

About the Survey
The online survey included responses from 7,407 insured household decision-makers who had either personally received medical care, or had a family member on their policy receive care in the past two years. Respondents included a representative sample in each of the 50 U.S. states and the District of Columbia. The survey took place from May 1 - June 1, 2014.

The survey sample was proportionally distributed among types of insurance plans. Specifically:

  • Employer-sponsored health insurance made up 54% of the sample compared to the actual U.S. Census figure of 55%
  • Individual plans made up 12% compared to the 2012 Census figure of 9.8%
  • Medicare accounted for 18% compared to the Census figure of 16%
  • VA/military health plans accounted for 4%, in line with the 2012 Census figure of 4%
  • Medicaid accounted for 9% compared to the Census figure of 16%

For more information about the survey, please visit: transunioninsights.com/healthcarecostsurvey

TransUnion Healthcare
TransUnion Healthcare, a wholly owned subsidiary of credit and information management company TransUnion, empowers providers with Intelligence in an Instant® by providing data and analytics at the point of need. TransUnion offers a series of data solutions designed to provide greater ease of use, accuracy and transparency in the revenue cycle process thereby assisting providers in lowering their uncompensated care. www.transunionhealthcare.com

About TransUnion
As a global leader in credit and information management, TransUnion creates advantages for millions of people around the world by gathering, analyzing and delivering information. For businesses, TransUnion helps improve efficiency, manage risk, reduce costs and increase revenue by delivering comprehensive data and advanced analytics and decisioning. For consumers, TransUnion provides the tools, resources and education to help manage their credit health and achieve their financial goals. Through these and other efforts, TransUnion is working to build stronger economies worldwide. Founded in 1968 and headquartered in Chicago, TransUnion reaches businesses and consumers in 33 countries around the world on five continents. www.transunion.com/business

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