Health Insurance 

Health Transparency

Improving Health Care Transparency in Texas


When evaluating consumer access to health care information, some important questions to ask are:  a) is the scope of the information sufficient? b) can consumers locate pertinent information? and c) is the information usable once it is found? While the state currently collects cost and quality data that is helpful to consumers, there are opportunities to improve where and how this information is presented. Under the current system, health plans, providers, and facilities are required to submit cost and quality data to several state agencies. The agencies then aggregate this data and provide it to consumers through various websites and reports. The result is compartmentalized information that is presented in a variety of formats that make it difficult for consumers to use. OPIC has several recommendations to improve the accessibility of this information:


1.  Evaluate Centralizing & Aggregating the State’s Transparency Resources

Dispersing healthcare cost and quality information among several state websites presents challenges to consumers. Information relating to plans, providers, and facilities is generally collected and reported by each entity’s respective regulatory agency. This arrangement requires consumers to navigate multiple websites that are presented in different formats. It also results in duplication that can create confusion, especially when the same information is presented in different ways. For example, at least four agency websites provide consumers an overview of cost-sharing (Consumer Guide to Health CareTexashealthoptions.comTexas Department of Insurance (TDI), and OPIC).

This compartmentalization of transparency information could be addressed in several ways. One option is to develop a web portal that would function as a hub for the state’s health transparency resources. Consumers could then use one website to access links to the various healthcare resources located on state agency websites. This approach would help consumers locate information that they might otherwise not be aware of and could be done through an existing website such as TDI’s or by creating a new website unaffiliated with a specific state agency. Another option is to consolidate the state’s transparency resources onto a single integrated website. A single website would facilitate comparison shopping by merging separate data sets into one website with uniform content and formatting.

Both of these options provide opportunities to improve healthcare transparency for consumers by making the state’s cost and quality data more transparent and useful. It is also important to note, however, that these options will take time, financial resources, and extensive interagency coordination to implement. This is particularly true in the case of the second option of a single integrated website.


2.  Make Content More User-Friendly

Much of the information provided on state transparency websites is presented in the form of tables, spreadsheets, or statistical charts that can be difficult to interpret. In addition, the information can be presented in highly technical language that is difficult for consumers to understand. Reports and queries also typically focus on specific variables, making it difficult for consumers to simultaneously consider multiple criteria.

Replacing highly technical language with plain language text and adding tools that allow consumers to sort and filter information or to compare multiple criteria simultaneously would help consumers identify the information they want to have when shopping for their healthcare coverage and facilitate a meaningful comparison of different plans, providers, and facilities.


3.  Assess the Scope of Information Provided to Consumers

Consolidating the state’s transparency resources would also enable an assessment of the scope of information provided to consumers. Under the current structure of multiple websites, providing more information to consumers is likely to have limited impact because of the difficulties that consumers presently have in locating information that is important to them. Some examples of information for which centralization would be particularly useful to consumers include provider fee and network adequacy information. Centralizing the various state agencies' transparency resources and reducing duplication across websites would allow policymakers to properly assess potential gaps in the information provided to consumers.


4.  Evaluate Health Insurance Literacy

 OPIC, TDI, and DSHS, in partnership with the Texas Legislature, should evaluate what can be done to improve health insurance literacy across the entire spectrum of consumers. A lack of awareness of health insurance literacy across all socioeconomic groups in the US has grown recently. This is also true in Texas. It is important to discuss options for the most effective way to increase understanding of basic health insurance terms and how resources can be best utilized to educate consumers so they are better able to understand the ramifications of their health care and insurance decisions.

[i] Sec. 501.251(a) and Sec.501.252(a), Insurance Code