It's not clear that consumers particularly care to learn about the full cost of their healthcare, according to Graybill: "98% of health plans have a transparency tool for members, but only 2% of members use it."
"There's something wrong with that dynamic," he added. Consumers need reasons to care about their aggregate health costs when they're not the ones fronting the money, and he believes that rewards and rebates are the answer. "On average across the country in 2014, we saved $600 per member -- counting savings being passed down to the member, employer, or another stakeholder," Graybill said. "The key is how to get them to become members in the first place, and that's where incentives come in."
Then there's the question of how the focus on cost-effectiveness will impact doctors. They may not like it, Halper said, "but they don't have a choice." Incentivizing cheap doctors and procedures above all else would place an undue emphasis on money over value, particularly when it comes to stellar doctors who charge high rates simply because they're the best at what they do.
"No one wants just the cheapest colonoscopy," said Jeanne Pinder, founder and CEO of ClearHealthCosts, a journalism startup that aims to tell people about the costs of their care by crowd sourcing information and creating its own transparency tool. "These cost metrics are not transparent, and the quality metrics are also not transparent."
If you can bring the price "out of the shadows," Pinder said, it will help consumers make informed decisions on the relationship between price and quality. "Say there's one $300 MRI and one $6,000 MRI--someone needs to explain why one is twenty times better than the other," she said.
Cost isn't everything, of course, Winokur said: it's not prudent to send someone to the lowest-cost provider if the practice is not a high-quality one.
But quality is increasingly being tied to doctor and hospital compensation. "Doctors and hospitals are ultimately paid more based on the quality of their outcomes," Halper said. Both Winokur and Halper feel that tying physician compensation to quality metrics will provide better quality of care to patients in the long run, because it provides an incentive to doctors to perform as well as possible and to price their services according. "We're pushing to have 50% of all our providers on value-based plans by next year, and 70% the next year," Winokur said.
But basing provider pay strictly on outcomes comes with difficulties of its own. In the words of an article in Minnesota Medicine, a regional medical journal, many current pay-for-performance models "do not reflect the complexity of caring for patients with multiple conditions." The article states, "Although pay-for-performance programs may drive improvements in care that can be measured, such care may be inconsistent with patient preferences. Programs with rigid measures and standards could create incentives for physicians to avoid high-risk patients and fire noncompliant ones."
Of course, in considering the cost, it's also important to consider administrative work associated with data collection and reporting -- resources that instead could be geared to patient care.
Despite the difficulties in transitioning to a new world order of cost-consciousness in health care--lackluster enthusiasm among patients, potentially misplaced motivations in the tug between cost and quality, administrative hurdles as the current institution shifts gears--there's something to be said for including patients as active agents with the ability to control of their own healthcare spending. And of course, a few rebates don't hurt to sweeten the deal.
More than anything, transparency is what's lacking most. "A lot of physicians don't even know what they get paid," Winokur said.
"I don't understand how we made a marketplace where everything defaults to secrecy," said Pinder. "It's a strange thing because we are a society that believes in democracy."