AT-A-GLANCE
“Team HPT has put in every effort to make our customers successful and help CMS move towards realizing the mission behind Hospital Price Transparency initiative. Congratulations Team HPT and thank you so much!”
– HPT developer
Pushing transparency in medical service and product costs for the masses
On January 1, 2021, the Centers for Medicare &Medicaid Services (CMS) rolled out Hospital Price Transparency (HPT), an initiative designed to oversee cost transparency in medical services and products offered to consumers across the United States. With a principal mission to enforce“clear, accessible pricing information online,” CMS now requires licensed hospitals or institutions that meet similar licensing requisites to provide:
1. A comprehensive machine-readable file with all items and services, and all items
2. A display of shoppable services in a consumer-friendly format.[1]
Governed by these two rules, HPT allows consumers to actively shop for health care with a clear discernment of market pricing, estimated and otherwise, encouraging them to select, budget, and save accordingly. CMS has been proactive in its push for HPT by making sure all who need standard medical treatment receive comprehensive, fair, and reliable pricing on all services and products.
At the start of this effort, CMS had been conducting compliance audits for select institutions while also investigating consumer complaints, of which the latter remains ongoing. To aid in this effort, CMS tasked Softrams with designing a tool to monitor HPT compliance and manage consumer complaints. Softrams created the HPT Management System (HPT-MS), a web-based application that documents investigations of any healthcare institution not complying with the new standards.
1. A comprehensive machine-readable file with all items and services, and all items
2. A display of shoppable services in a consumer-friendly format.[1]
Governed by these two rules, HPT allows consumers to actively shop for health care with a clear discernment of market pricing, estimated and otherwise, encouraging them to select, budget, and save accordingly. CMS has been proactive in its push for HPT by making sure all who need standard medical treatment receive comprehensive, fair, and reliable pricing on all services and products.
At the start of this effort, CMS had been conducting compliance audits for select institutions while also investigating consumer complaints, of which the latter remains ongoing. To aid in this effort, CMS tasked Softrams with designing a tool to monitor HPT compliance and manage consumer complaints. Softrams created the HPT Management System (HPT-MS), a web-based application that documents investigations of any healthcare institution not complying with the new standards.
The Challenge
“Thank you again every single member that contributed to HPT Program. Keep rocking!"
– HPT developer
Affordable health insurance in the United States— irrespective of health status, age, and other common factors — has steadily increased the use of health care.
By curbing the costs of health insurance, the United States has mended significant rifts in the healthcare system, offering millions of Americans access to better health. However, with rising healthcare costs, the average household has less to spend on everyday goods and services.[2]
According to recent studies, the cost of health care in the United States is significantly increased by the price of medical services and products, accounting for 90% of healthcare spending.[3] These expenses in turn limit access to health care for those with chronic health conditions and adversely affect an aging population. As the access to affordable health care declines, so does maintaining viable retirement savings for older Americans, offering decent, unabridged salaries to the working class, and avoiding economic downturns as consumers spend less and less on other goods and services.
After the launch of HPT, it was imperative that CMS monitor healthcare institutions for compliance. Softrams decided to first tackle the problem by engaging each stakeholder group.
According to recent studies, the cost of health care in the United States is significantly increased by the price of medical services and products, accounting for 90% of healthcare spending.[3] These expenses in turn limit access to health care for those with chronic health conditions and adversely affect an aging population. As the access to affordable health care declines, so does maintaining viable retirement savings for older Americans, offering decent, unabridged salaries to the working class, and avoiding economic downturns as consumers spend less and less on other goods and services.
After the launch of HPT, it was imperative that CMS monitor healthcare institutions for compliance. Softrams decided to first tackle the problem by engaging each stakeholder group.
The Payoff
Journey through the lenses of real people.
To create a proper application design, Softrams engaged stakeholders at every level — from actual CMS auditors and contractors to hospital staff. These individuals were instrumental in the system’s design, which helped us determine a viable technology stack for the design-build. Using multiple user experience patterns and complex questionnaires for focus views, we were able to construct a model that addresses several areas of concern with the current manual workflow process by creating a flexible, user-friendly instrument capable of managing a variety of options and nuances.
Users screen for HPT hospitals
What we did
A functional system with a reliable user interface.
Employing an efficient, flexible technology stack, front-ended by a user interface built with ReactJS, we took a complex process — run by email correspondences, Excel spreadsheets, SharePoint folders, Jira tickets, and in-person exchanges — and created a virtual environment to handle it all. The application is designed to not only manage everyday workflows but also generate important documentation used to support press releases, Inspector General reports, congressional briefings, and other transformative, law-making records.
Following the launch of HPT-MS on August 3, 2022, Softrams’ commitment to the all-encompassing, balanced system for managing HPT is ongoing. As we continue our efforts to enhance the application’s current technology stack in the coming months, our focus will be to construct the next generation of the system.
Following the launch of HPT-MS on August 3, 2022, Softrams’ commitment to the all-encompassing, balanced system for managing HPT is ongoing. As we continue our efforts to enhance the application’s current technology stack in the coming months, our focus will be to construct the next generation of the system.
Users screen for HPT complaint tracker
The Results/Metrics (numbers)
The Softrams human-centered design (HCD) team worked with research study participants to evaluate the Case Tracker page and understand user behavior. The work involved the following central thread:
- Evaluate the initial review, including:
- A Provide Evidence flow, and
- A Shoppable Service table - Evaluate the case process of different review activities
- Evaluate other functionalities such as an Edit Request flow, email notifications, and so on
- Understand each user role’s main tasks, needs, and goals within the system
4
User Personas / Participants in the Evaluation
- CMS QA Analyst
- CMS Administrator
- Compliance Analyst
- Compliance Supervisor
- CMS Administrator
- Compliance Analyst
- Compliance Supervisor
10
Evaluations Conducted
Evaluators Made
9
Findings
12
Feedback comments
10
Recommendations
Results
10
User stories created & Implemented
19
Tasks identified for future research and development
