Revolutionizing Healthcare Costs: New Mexico’s Game-Changing Website!

New Mexico is building a website to bring transparency to health care pricing

In a bid to provide New Mexicans with comprehensive insights into healthcare costs, state health officials have revealed plans to launch a dedicated website by the spring of 2024. This initiative comes at a critical juncture when hospitals in New Mexico and across the nation are facing criticism and penalties for failing to comply with federal pricing transparency laws.

The project, known as the All-Payer Claims Database, aims to facilitate a reduction in healthcare costs by offering a user-friendly platform featuring detailed cost comparisons for healthcare services, procedures, and drugs. Ken Geter, the state’s chief of the Community and Health Systems Epidemiology Bureau, emphasized the importance of this database, stating that it will provide “a robust database with an intuitive, navigable website with easy access by all users.”

Geter further explained that the primary goal is to enhance transparency in healthcare pricing, ultimately leading to reduced costs for consumers. Notably, New Mexico’s Department of Health’s planned website distinguishes itself from the federally mandated “standard charges files” that hospitals are required to post annually.

Under federal law, these files must be easily accessible and searchable by both humans and machines. They should encompass all items, services, procedures, and drugs for all insurance plans, along with minimum and maximum negotiated rates and discounted cash prices. However, Geter acknowledged that these hospital standard charges files are often challenging to decipher and navigate.

Kristina Fisher, the associate director of Think New Mexico, a political think tank that supported the creation of the website, drew a comparison between current federal pricing transparency requirements and the proposed New Mexico database. She likened the difference to that between the sticker price of a car and the actual price paid. According to Fisher, the current transparency measures are valuable for studying hospital pricing trends but lack user-friendliness.

A report released by the nonprofit organization Patient Rights Advocate in July found that nine out of 14 New Mexico hospitals examined were not compliant with the 2021 federal rule designed to provide consumers with access to the cost of their healthcare.

The New Mexico Health Information System Act, established in 2015, was designed to assist health officials, legislators, and consumers in making informed decisions regarding healthcare. Fisher clarified that while the database will not operate in real-time, it will be kept fairly up-to-date, with only a few months’ lag.

Current standard charges files differ from one hospital to another and are often intricate and extensive, making it a time-consuming process for consumers to compare prices across hospitals. The planned New Mexico system will be based on actual charges provided by insurance companies, simplifying the process for ordinary individuals.

Geter mentioned that state officials sought assistance from the National Association of Health Data Organizations to acquire and download claims files charged to New Mexico’s numerous insurance companies. They also studied the experiences of other states that have successfully implemented all-payer claims databases.

“We’ve been in discussions with Colorado, Virginia, and Rhode Island,” Geter explained. “We’re striving to make it as effortless as possible for the public to access quality-of-care metrics for various facilities and providers.”

Upon its completion, New Mexico will join the ranks of 19 states that have established their own claims databases, including Texas, Florida, and California. Meanwhile, Nevada, Indiana, and Georgia are in the process of creating their own websites.

Originally scheduled for completion this year, New Mexico’s website launch was delayed due to the complexities discovered during the project’s development, as explained by David Barre, a spokesperson for the state Department of Health.

In contrast, Texas operates a health information site managed by the University of Texas Center for Healthcare Data, which collects medical and pharmacy claims representing 65% of the state’s population. Visitors to the site can explore aggregate data or search based on cost, utilization, condition, quality, wellness, and risk. The site also offers a rankings dashboard summarizing data from hospitals and healthcare facilities in numerical scores.

Nat Dean, a healthcare advocate in Santa Fe, emphasized the importance of consumers becoming familiar with such websites before the need arises. Dean stated that information and knowledge are powerful tools that should be readily accessible. In complex situations, consumers often check prices for various aspects of their lives but neglect to do the same for their healthcare. Dean stressed the importance of users actively engaging with healthcare pricing information to make informed decisions.