Payment reform, transparency of health care costs, and changing the way employers buy health care. Those are three of the main initiatives being put forward by the Colorado Business Group On Health under the leadership of Executive Director, Donna Marshall. Donna, a registered nurse and passionate health care reform advocate, has led the organization since 1996.

In an interview with Catherine Strode of AdovcacyDenver, Donna explains her vision of health care reform in the coming year. She says consumers can have a big impact in helping to create transparency in health care costs and can benefit greatly when health care fees transition from fee-for-service to bundled payments.

When you use the term ‘transparency’ in health care, what do you mean?

“We are using the term ‘transparency’ to mean that health care is not so much a black box. It is more an opportunity for people to find the information they need about what a procedure might be, where you might go to get a procedure (in terms of a high quality place,) and how much it will cost. What we find now for consumers, and for employers as well, is if your physician recommends you get a colonoscopy or an MRI, for example, they will give you a recommendation or say “Look it up in a plan directory or online.” What consumers have not had access to is information that shows the different costs at each facility. Costs, from even routine procedures, will vary as much as 400%. In the past, that wasn’t as much a problem for consumers. They would have a simple co-pay or they would go and get an MRI done and have a fixed amount. Today, in the world of the high deductible health plans, you find yourself paying for that MRI out of pocket. If you can get that same procedure for $200, do you really want to spend $1200?”

How can consumers impact health care cost transparency?

“We think consumers are going to really impact the marketplace in 2015 in a way they haven’t done before. There are three ways I would recommend that consumers get more involved. One way is that many health plans now show what the costs of these procedures are at various locations on their website. Most of your major health plans will have an application on the website where consumers can shop for price and for quality. A second way is that many employers are involved with the Colorado Business Group On Health and we are promoting cost transparency through some of the work we’re doing with data and information. A third resource is the Colorado All Payer Claims Database which is available at www.comedprice.org. This database allows you to see costs and a link to hospitals in the state. They are adding new features all the time to help consumers be better informed. This will really change up the marketplace.”

In addition to transparency of costs, what are there other main initiatives of the Colorado Business Group On Health?

“We believe there is a grand opportunity to start bundling payments for services. If you’re having a knee replacement surgery, you should be able to find a high quality provider and you should be able to pay one price that will include the cost of the hospital, the cost of the surgeon, the cost of the anesthesia, and the cost of the implant device, which is frequently thousands of dollars. In addition to knowing what a fair price is for a procedure like a knee or hip replacement surgery, you should be able to get a warranty. You should be told that if you have a surgical site infection or your rehabilitation is not going well, that those are covered for 60 or 90 days after the procedure. There should be a guarantee that you have a good outcome at a fair price. This is a monumental shift in how we think about health care and health care costs.”