Report: Healthcare costs could vary greatly depending on the health plan

With healthcare costs projected to rise 9% in 2026, it seems employers and patients alike can’t expect a slowdown in spending anytime soon.

Bills and executive orders have been proposed to establish price transparency about healthcare costs, so patients can know what they’re expected to pay up front.

Now, Trillium Health is giving a look into the numbers.

The healthcare analytics company published last month a large study (2,659 hospitals and 3,491 ambulatory surgery centers across the nation) that provides some insight into these rising costs.

The report used data provided through the Centers for Medicaid and Medicare Services (CMS) Transparency in Coverage rule, a 2020 regulation that requires health plans to share out-of-pocket cost information and negotiated rates. The idea was to give patients information about how much they’re expected to pay before care is delivered.

But when payers started reporting this information in July 2022, the data was hard to sort through due to the “complexity and extremely large” files, the Peterson-KFF Health System Tracker, which monitors health spending, reported in February. Trillium Health sorted through the data, and ultimately found great variation in what hospitals, payers, and patients spend on the same care.

Report breakdown. While patients who are publicly insured pay rates set by CMS, commercially insured patients’ rates are individually negotiated between insurance companies and providers. As a result, patients with different health plans get billed different amounts for the same procedure.

For example, the report looked at negotiated rates for six inpatient treatments like coronary bypass, bowel movement procedures, and hip, knee, and ankle surgeries. Among 101 hospitals in Pennsylvania, UnitedHealthcare’s negotiated rates for a bowel procedure involving a complication or comorbidity could cost anywhere from $18,066 to $87,457.

There was even price variation within some hospitals, the report found. At Tufts Medical Center in Boston, the negotiated rates for a coronary bypass involving major complications or comorbidities were $95,989 with Aetna and $144,204 with United, according to the report.

The report also found care largely costs less at ambulatory surgery centers compared to outpatient hospital departments (e.g., $1,179 compared to $3,633, respectively, for a colonoscopy). This difference in price presents an annual $4.5 billion in “potential savings” for colonoscopies at ambulatory centers, according to the researchers.

Wait, there’s more. Here are a few other things worth noting:

• US health spending in 2023 was $4.9 trillion, or $14,570 per person.
• Spend in the US is 139% higher than Switzerland, which has the next-highest spend per person.
• The report found “no observable correlation” between cost and quality of care at 10 providers featured on three best hospitals lists.