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STATE | ASPS Subject Matter Expert Teams Comment on "Right to Shop" Legislation

New Hampshire worked with Anthem Blue Cross and Blue Shield to develop a program to financially incentivize state employees to visit lower cost health care providers. Several years into the program, New Hampshire has saved $12 million dollars with over $1 million paid out to patients as rewards. Due to the positive financial impact, many states have considered legislation that would implement this type of program, making this issue a new and emerging legislative trend.

"Right to Shop" legislation typically directs an insurer to design a program where patients are encouraged to obtain lower cost health care services in exchange for a financial kick-back. If a patient obtains a lower cost health care service than the average price the insurer pays for the service, the health insurer will pay the patient a portion of the difference to the patient. These legislative proposals also typically contain a number of provisions requiring price transparency.

The Society's Legislative Advocacy Committee's physician leaders and Subject Matter Expert Team (SME) for Out-of-Network Billing reviewed this legislation and identified the potential implications on the healthcare delivery system. The group determined that provider, facility and insurer price transparency are positive improvements to the existing system, especially when there is a keen focus on insurer transparency. Additionally, the SME raised issue with creating a "race to the bottom" by providing incentives to patients to obtain the cheapest care without considering factors for quality and competence. The group was also concerned with how out-of-network care would be treated in the program and stressed that physicians must be able to monitor and edit any profiles and descriptions created. Comments from these advocacy leaders were instrumental in forming the Society's position on this legislation when it recently surfaced in Montana.

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