BILL REQ. #:  S-3488.1 

Read first time 01/17/14.   Referred to Committee on Health Care .

     AN ACT Relating to transparency tools for consumer information on health care cost and quality; adding a new section to chapter 48.43 RCW; and creating a new section.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION.  Sec. 1   Consumers face a challenge finding reliable, consumer friendly information on health care pricing and quality. Greater transparency of health care prices and quality leads to engaged, activated consumers. Research indicates that engaged and educated consumers help control costs and improve quality with lower costs per patient, lower hospital readmission rates, and the use of higher quality providers.
     Washington is a leader in efforts to develop and publish provider quality information. A newly released national report on improving health care quality and value named Washington as one of only two states to receive an A grade on the transparency of physician quality reporting. Conversely, information on health care costs are evolving slowly and a recent report card on price transparency issued jointly by two national groups awarded Washington an F grade for price transparency.
     Although data is available today, research indicates the existing information is not user friendly, consumers do not know which measures are most relevant, and quality ratings are inconsistent or nonstandardized. It is the intent of the legislature to ensure consumer tools are available to educate and engage patients in managing their care and understanding the costs and quality.

NEW SECTION.  Sec. 2   A new section is added to chapter 48.43 RCW to read as follows:
     (1) All health plans offered or renewed on or after January 1, 2016, must include consumer transparency tools with price and quality information. The transparency tools must aim for best practices and, at a minimum:
     (a) Must combine quality and cost data;
     (b) Must include a patient review option or method for members to provide a rating or feedback on their experience with the medical provider that allows other members to see the patient review;
     (c) Must have mobile applications to allow people to access the data on a mobile device while sitting in the doctor's office;
     (d) Must display side-by-side comparisons that let consumers know their best options;
     (e) Must display the cost for the member of estimated out-of-pocket charges to the member with the application of personalized benefits such as deductibles and cost-sharing, along with the overall cost that the employer or plan will be paying;
     (f) Should provide quality information with a value rating of the medical provider that is a blend of cost, quality, and user experience measures; and
     (g) Must display alternatives that are more cost-effective when there are alternatives available, such as the use of an ambulatory surgical center when one is available.
     (2) In addition to required features on cost and quality information, the transparency consumer tools must include information to allow a provider search, with indicators for in-network designation, of specialists, distance from patient, whether the provider is accepting new patients, the provider's education, board certification and other credentials, affiliated hospitals and other providers in a clinic, maps and driving directions, and other information to assist in choosing a provider.
     (3) The commissioner must review the transparency tools to ensure the required features are available, visible on the front page of the health plan web page, and easy to use and understand. The commissioner may request information be submitted with the rate filing or through a separate process. The commissioner may write rules to detail the procedures and timelines for the review.