State insurance regulators are exploring ways to make New Hampshire’s health care market more transparent – and keep rising medical costs in check.
New Hampshire is already one of the few states with a comprehensive online tool that lets patients compare what different providers charge for common medical procedures. The rollout of that website, NH HealthCost, in 2007, led to lower prices over time, according to a 2018 study that looked at medical imaging services.
State insurance officials say they’d like to build on that success. On Friday, the New Hampshire Insurance Department hosted three experts for a panel on price transparency at its annual hearing on health care premiums.
Insurance Commissioner D.J. Bettencourt called price transparency a “long-term project” of the department. He said the ideas discussed Friday could inform policy discussions with the governor and lawmakers.
“The key takeaway, I think, is that price transparency works as a fundamental matter,” he said after the panel, held at UNH’s Franklin Pierce School of Law in Concord. “The key is how do you best approach it?”
This comes as the healthcare industry in New Hampshire and the rest of the country is growing more consolidated. The experts who spoke Friday said those mergers tend to lead to higher prices.
“Hospitals that are in a dominant market position are ones that are able to command higher prices,” said Chris Whaley, an associate professor at Brown University’s School of Public Health and health economist at the nonprofit research group the Rand Corporation.
By contrast, he said there’s only a “minimal” correlation between what a hospital charges and the quality of its services.
Whaley presented data on how expensive different health systems are, using what Medicare pays as a baseline. He said those prices can vary widely.
In New Hampshire, for instance, North Country Healthcare charged commercially insured patients about 1.5 times what Medicare pays, according to claims data from 2018 to 2020 analyzed by Rand Corporation researchers. Meanwhile, prices at HCA Healthcare and LRGHealthcare (which has since become part of the Concord Hospital system) were around three times the Medicare rates.
“Even among hospitals in the state of New Hampshire, there's roughly a 2x range in prices,” Whaley said.
Dr. Zach Brown, a health economist at the University of Michigan who wrote the study on the NH HealthCost website, said transparency can reduce prices by allowing patients to shop around and giving employers more information as they choose networks. It can also lead to scrutiny from reporters and regulators, which may put pressure on health care providers to lower prices.
“One study found that nationally, 10% of individuals pay less than $700 for an MRI,” he said. “However, there's 10% of individuals that pay over $2,000 for the exact same MRI.”
But for transparency to be effective, Brown it may need to be combined with other policies – like interventions to prevent health care monopolies.
“If individuals can't shop, if there are no choices, then we wouldn't expect price transparency to do anything,” he said.
Maureen Hensley-Quinn of the National Academy for State Health Policy, a nonpartisan health policy organization, said states are starting to ban certain anti-competitive contracting practices.
“You can't unwind some of the relationships and mergers and affiliations that have happened,” she said. “However, you could try to mitigate some of the anti-competitive behavior that happens once that takes place.”
Bettencourt said the presentation had “a lot of good ideas” when it comes to analyzing the contracting process between insurance carriers and health care providers.
“We want to ensure that the consumer is benefiting from the free market system, which means that there needs to be healthy competition,” he said.
