Over the past few years federal policymakers have instituted healthcare price transparency. Until last year, healthcare prices were largely, if not altogether, unknown to patients. As of this past July 1 most group health plans and issuers of group or individual health insurance are required to publicly disclose pricing information. As of this past January 1, providers were no longer able to surprise or balance bill patients for care they unknowingly received from providers outside their insurer’s network. As of January 1, 2021 hospitals have been required to provide clear & accessible pricing information about the items and services they provide. Though price transparency is sound in theory, what effect, if any, it will have on patient or consumer decision making, reducing price growth and influencing care delivery and innovation are largely unknown.
During this 36 minute conversation , Mr. Albright begins by briefly describing work done by Zelis. He moves on to discuss/explain why healthcare price transparency took so long, what specific price data are hospitals and payers required to publicly disclose, how will employer-based insurers use the transparent data, he comments on hospital compliance or lack thereof, related state price transparency efforts and concludes with a comment regarding how and why price transparency will finally be realized.
Mr. Matthew Albright is currently Chief Legislative Affairs Officer at Zelis. Prior to joining Zelis, Matthew oversaw the certification
program at the Center for Affordable Quality Healthcare (CAQH) and Committee on Operating Rules for Information Exchange (CORE) to ensure conformance with the requirements of the Patient Protection and Affordable Care Act (PPACA). He also served as Director of the Administrative Simplification Group for the Centers for Medicare and Medicaid Services (CMS). In this role, Matthew was responsible for drafting the regulations that implemented Section 1104 of PPACA which specifies the requirements of the Health Insurance Portability and Accountability Act (HIPAA) administrative transactions. Matthew is a published author on bioethics, has written numerous state and federal regulations, and taught as adjunct faculty at St. Martin's University and Pierce College in Washington State. Mr. Albright earned a Master of Divinity from Harvard University with an emphasis in Bioethics, a BA in Religion Studies from the College of Santa Fe and a BA in Print Journalism from the University of Southern California.