As consumers increasingly are being asked to pay a larger share of their health bills, a coalition of insurers, pharmaceutical companies, and provider and consumer advocacy groups launched Thursday a new push for greater transparency regarding the actual costs of services.

The group includes AARP, Novo Nordisk, the National Consumers League, the Ambulatory Surgery Center Association, the National Council for Behavioral Health and Aetna.

Health care transparency, long a buzz word, means all consumers — whether they are covered by Medicare, work-based insurance or without coverage at all — have access to information enabling them to estimate accurately the cost of health services, and compare physician quality rankings and outcomes.

The initiative, “Clear Choices,”  will add to private and government efforts already underway to get more such information to patients, including Medicare’s Physician Compare, and the Health Care Cost Institute’s ‘Guroo,’ which culls data from private insurers to provide average prices regionally.

The group’s first priority is advancing the Medicare doctor payment legislation pending in the Senate because it includes a provision requiring Medicare to release for broader use a substantial amount of data on claims at the provider level.

“We have data, but it’s a random sample across entire nation. So you can’t use it to do what Clear Choices and other organizations want to do — to analyze the cost and quality of individual providers within the Medicare program,” said Francois de Brantes, executive director of the Health Care Incentives Improvement Institute, a nonprofit group that studies and promotes payment reform. It is not affiliated with the initiative.

Another priority is to push states and the federal government to enforce the part of the health care law that requires exchange plans to give consumers very specific information about provider networks and covered drugs.

“Insurance company rates are negotiated, so each patient would be subject to a different rate,” said Caroline Steinberg, vice president of trends analysis at the American Hospital Association, which is not involved in the campaign. That negotiated rate means a consumer will likely pay less money for an in-network doctor or hospital. But they need a way to find out that information.

Some states already have moved in this direction.

For example, Connect for Health Colorado, Colorado’s state exchange, provides a tool for shoppers to compare insurers based on what drugs are covered, and what providers are in network.

The coalition’s most lofty goal is to change the health system so that patients can know upfront the cost of a medical procedure. This is a complicated proposition because so many components – among them facility-use fees, physician charges, deductibles and co-payments – are factored into the bill a patient eventually receives.

Wanda Filer, a physician based in York, Penn., says even health care providers are often confused by pricing.

“Physicians don’t even know where to refer people and they don’t know what to tell them,” said Filer, who is on the board of directors of  the American Academy of Family Physicians, which is part of the coalition.

Representatives of Clear Choices have framed the campaign as being simple – if a consumer can get a sticker price for a television, so should they for health care. But others say this is much harder than it might appear.

“It’s like asking what the price [will be] for the repair of a leaky roof before the roofer has figured out the cause of the leak,” said Mark Pauly, professor of health care management at the University of Pennsylvania. “It’s harder for the insurer to tell you what you will end up paying until you have precise information on what services you will be using—which patients (and, for that matter, doctors) do not always know in advance.”

The group’s other objectives include:

– Improving quality measures for doctors and hospitals so that patients will be armed with more comparative information.

– Requiring hospitals to be clearer regarding what may or may not be included in their cost estimates for care.

– Creating better tools for consumers to make medical decisions based on price, quality and safety of medical services.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Medicine has changed a lot in the past 100 years. But medical training has not.

Until now.  Spurred on by the need to train a different type of doctor, medical schools around the country are tearing up the textbooks and starting from scratch.

Most medical schools still operate under a model pioneered in the early 1900s by an educator named Abraham Flexner.

“Flexner did a lot of great things,” said Raj Mangrulkar, associate dean for medical student education at the University of Michigan Medical School. “But we’ve learned a lot and now we’re absolutely ready for a new model.”

And Michigan is one of many schools in the midst of a major overhaul of its curriculum.

For example, in a windowless classroom, a small group of second year students are hard at work. They’re not studying anatomy or biochemistry or any of the traditional sciences. They’re polishing their communications skills.

In the first exercise, students paired off and negotiated the price of a used BMW. Now they’re trying to settle on who should get credit for an imaginary medical journal article.

“I was thinking, kind of given our background and approach, that I would be senior author. How does that sound to you?” asks Jesse Burk-Rafel.

It may seem like an odd way for medical students to be spending their class time. But Erin McKean, the surgeon teaching the class, says it’s a serious topic for students who’ll have to communicate life and death matters during their careers.

“I was not taught this in medical school myself,” says McKean. But she says today communication is more important than ever. “We haven’t taught people how to be specific about working in teams, how to communicate with peers and colleagues and how to communicate to the general public about what’s going on in health care and medicine,” she says.

It’s just one of many such changes. And it’s dramatically different from the traditional way medicine has been taught. Flexner’s model is known as “two plus two.” Students spend their first two years in the classroom memorizing facts and their last two shadowing other doctors in hospitals and clinics. Mangrulkar says when the curriculum was instituted it was a huge change from the way doctors were taught in the 19th century.

“Literacy was optional, and you didn’t always learn in the clinical setting,” he says. Shortly after Flexner published his landmark review of the state of medical education, dozens of the nation’s medical schools closed or merged.

But today, says Mangrulkar, the two-plus-two model doesn’t work. For one thing, there’s too much medical science for anyone to learn in two years – and most information can be quickly accessed from a smartphone or tablet. At the same time, medicine is constantly in flux. What Michigan and many other schools are trying to do instead is prepare doctors for the inevitable changes they’ll see over their practice lives.

“We shouldn’t even try to predict what that system’s going to be like,” he says. “Which means we need to give students the tools to be adaptable, to be resilient, to problem solve, push through some things, accept some things, but change other things.”

One big change at many schools is a new focus on learning not just how to treat patients, but about how the entire health system works.

Susan Skochelak is a vice president with the American Medical Association, in charge of an AMA effort that is funding changes to medical school programs at 11 schools around the country. She says the new focus has had an added benefit: Faculty members are learning right along with the students about some of the absurdities in the system as it is today.

Only because they have to guide students through the system do they discover, for instance, that some hospitals schedule patients for tests like MRIs around the clock. “And one of my patients had to come and get their MRI at 3 am. How do they do that? They have kids! ” she says faculty members have told her.

Sometimes it’s not doctors who are the best teachers about how the system works.

Doctors tend to focus on patient care, since that’s what they know, she says, but when it is time to learn about the system as a whole, it can be more fruitful to hook students up with the clinic managers.

Another major change is making sure the next generation of doctors is ready to work as part of a team, rather than as unquestioned leaders.

In another classroom at the University of California-San Francisco, several groups of students are practicing teamwork by working together to solve a genetics problem.

Joe Derisi, who heads the biochemistry and biophysics department at UCSF, is more guiding than teaching, as he gently suggests a student’s tactic is veering off course: “I would argue that it may not be as useful as you think, but I’m obliging.”

Onur Yenigun, one of the students in the class, says that working with his peers is good preparation .

“When I’m in small group I realize that I can’t know everything. I won’t know everything,” he says. “And to be able to rely on my classmates to fill in the blanks is really important.”

The medical schools that are part of the AMA project are already sharing what they’ve learned with each other. Now plans are in the works to begin to share some of the more successful changes with other medical schools around the country.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

A California bill that would allow parents to opt out of mandatory school vaccinations for their children only if they have a medical condition that justifies an exemption was endorsed by a state Senate committee but still has a long, controversial path before becoming law. The bill was introduced in the California Senate in response to a measles outbreak at Disneyland in late December that’s now linked to almost 150 infections.

With several hundred protesters outside the Capitol building in Sacramento Wednesday, the bill sparked a debate about individual rights and responsibilities.

Vaccine opponents, who have been relatively quiet during the measles outbreak, turned out in force. They wore American flags, and one child held a sign that said, “Force my veggies, not vaccines.” The opponents say eliminating California’s current exemption that allows parents to refuse vaccinations for their children based on personal beliefs will threaten their ability to do what’s right for their kids.

“I think that everybody should be able to make their own choice,” said Lisa Cadrain of Los Angeles, who fears vaccines would harm her daughter. “I am afraid that her big beautiful blue eyes will not focus on me anymore, and she won’t be the kid that she is.”

Some opponents fear that the vaccinations are linked to an increase in the number of cases of autism in the country, but scientific studies show no link between vaccines and autism spectrum disorder.

Inside the hearing, parents who support the bill also talked about protecting their kids — from children who aren’t vaccinated. Democratic state Sen. Lois Wolk is on the Senate Health Committee and said she’s a strong proponent of vaccinations.

“Our individual rights aren’t without limits, and in this particular case, your insistence on your right really could harm my children or my grandchildren,” Wolk said.

Parents also testified in support of the bill, including Ariel Loop, whose baby son Mobius contracted measles in the Disneyland outbreak. Now 7 months old, he was too young to be inoculated when he was exposed to the virus.

“I understand being skeptical and wanting to research and do what’s best for your child,” Loop said. “I had actually looked into the alternate [vaccination] schedules myself. But there’s no science in support of it, and I’ve got to go with science. I don’t know better than all of these doctors.”

Children typically receive their first measles, mumps and rubella vaccine between 12 and 15 months of age. When enough of a given population is inoculated “herd immunity” protects babies less than a year old and other people who can’t be vaccinated from being exposed to the diseases.

The Senate health committee passed the bill 6 to 2 on Wednesday. That was just the first step – the legislation has many more hearings before it could become law. Meanwhile, Washington, Oregon and North Carolina have also considered legislation to limit families’ rights to opt out of mandatory vaccinations, and all of those efforts have stalled. West Virginia and Mississippi are the only states that allow no exemptions to their vaccine laws for personal beliefs or religion.

This story is part of a reporting partnership that includes Capital Public Radio, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Moderate Republicans have outmaneuvered conservatives in the Montana legislature to give a Medicaid expansion bill here a real chance of passing. Its prospects have been in doubt since the legislative session began in January.

The bill faces a crucial debate and vote on the state House floor Thursday. If the Republicans who joined with Democrats to overcome attempts to kill it don’t stray, it has the votes to pass. Pending the governor’s signature and approval from the federal government, the bill would make Montana the 29th state – plus the District of Columbia — to expand Medicaid.

As in 2013, the last time Montana’s every-other-year legislature met, Republicans hold strong majorities in both houses. An attempt to pass Medicaid expansion in 2013 failed.

So no one was really surprised this year when Democratic Gov. Steve Bullock’s Medicaid expansion plan was shot down in its first committee hearing last month.

But a similar bill subsequently brought by Republican Sen. Ed Buttrey of Great Falls won every Senate Democrat’s support, and seven Republican votes, enough to send it to the House.

Like the governor’s proposal, Buttrey’s bill would accept federal funds under the Affordable Care Act and extend benefits to non-disabled adults without children, proposals that are non-starters for many conservative Montana Republican lawmakers. But unlike the Democratic proposal, it would require recipients to pay premiums and participate in “workforce development” programs aimed at moving people off of Medicaid and into jobs that pay enough to qualify for federal subsidies to buy private coverage on HealthCare.gov.

Buttrey’s bill faced an uphill battle when it got to the House. It landed in the same committee that killed the governor’s bill, headed by conservative Republican Rep. Art Wittich of Bozeman.

“That this compromise is widely shared is hogwash,” Wittich said after his committee heard more than four hours of testimony Tuesday. Proponents who came to speak included hospital and business interests. Opponents, organized with the help of the Koch brothers-funded group Americans for Prosperity, turned out a larger group than testified against even the governor’s bill.

“The reality is that 85 percent of the Republican caucus does not support [Buttrey’s bill],” Wittich said. “They were never consulted. They were never negotiated with.”

The committee’s Republican majority then voted to give the bill a “do not pass” recommendation on Tuesday. That meant it would need a supermajority of 60 House members to vote to keep the bill alive, an insurmountable hurdle.

That’s when Democrats fired a “silver bullet,” and hours of legislative gymnastics around arcane procedural rules over two days began.

In the early days of the legislative session in January, leaders from both parties agreed to give each other six “silver bullets” to “blast” pet bills out of unfavorable committees and onto the House or Senate floor for broader debates and votes.

House Republican leadership argued the Democrats couldn’t do that with the Medicaid bill, but eventually 11 members of their party split and sided with Democrats, bringing the Medicaid expansion bill to the full House, which will debate it and vote on it Thursday night.

Republican representatives are sure to face strong pressure to vote against the bill. Critics deride it as implementation of the loathed Obamacare. On the other hand, lawmakers have heard testimony from people like 54-year-old pizza delivery driver Max Naethe of Kalispell, Mont., who has diabetes and heart problems. He makes too much to qualify for Medicaid, but too little to get an Affordable Care Act subsidy for private insurance premiums.

“I don’t think anything Obama is a good idea,” Naethe says, but, “there are people out here whose lives literally hinge on this bill. It’s crucial that this be pushed through.”

Nor are all Montana Democrats entirely comfortable with the only Medicaid expansion bill left before them, written as it is by a Republican.

“There are lots of things in the bill that, quite frankly, I struggled to accept,” said House Minority Leader Chuck Hunter. “But I think [it’s] in the spirit of having something that works for both sides of the aisle to accept.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

At an Institute for Family Health center near Union Square in New York City, medical student Sara Stream asks a new patient named Alicia what brings her in. It’s been many years since the 34-year-old patient, who arrived last summer from Guatemala, has seen a doctor.

Her list of ailments is long.

“I have trouble seeing, headaches, problems with my stomach,” says Alicia, who declined to use her full name, because she is in the country illegally. “I feel depressed.”

Stream takes the problems one by one, carefully asking follow-up questions about when symptoms started, when they recur, where they’re felt, and what Alicia thinks the causes might be. Stream is using a translator, who also happens to be her supervisor, Dr. Amarilys Cortijo. As the symptoms pile up, Cortijo steps in.

“A lot of the symptoms she has are somatic,” says Cortijo. “We’ll have to deal with the complaints and try to get to the root, which is probably all the emotional turbulence that is taking place.”

Cortijo works for the Institute for Family Health and is co-director of two student free clinics — one the Institute runs in the Bronx with volunteer students from Albert Einstein College of Medicine and this one, downtown, which the Institute runs with volunteer students from New York University School of Medicine. Many other medical schools around the country run similar clinics that treat uninsured people for free. They typically meet once a week, taking in a few dozen patients per session, and treating several hundred patients over the course of a year.

The programs are among the most popular extracurricular activities at medical schools, and at some institutions almost all students volunteer at some point during their training.

Students do everything. First- and second-year students perform more administrative tasks, such as running the reception desk, coordinating lab tests and follow-up treatment and fund-raising. Third- and fourth-year students see patients, with faculty physicians overseeing all formal diagnoses and prescriptions.

At the NYU clinic, students increasingly have had to help drum up business. Many of the core patients in the Union Square area picked up Obamacare coverage, leading to a 25 percent decline in visits last year.

“A lot of our patients had been freelance people, who were the most likely to benefit from the changes in health coverage,” says Dr. Sarah Nosal, co-director of the program.

So NYU students have had to go out recruiting in a way they didn’t need to before, heading to churches and community centers in neighborhoods farther away, to let people like Alicia know about the free healthcare they could get if they come to the clinic.

“[The students have] reached out to communities where undocumented people were and made them aware of our resources,” Nosal says.

But these free clinics are not major venues for taking care of the uninsured. Most of the close to 2 million uninsured people in New York state and 1 million in the city get health care in emergency rooms, city hospitals or community health centers — if they get it at all.

Still, Dr. Neil Calman, head of the Institute for Family Health, said the clinics perform a valuable service for both patients and future physicians.

“This is an opportunity for medical students to get involved in the business end of seeing what health care is like for people who don’t have the same kind of access that they have to it,” he says. “It’s really a learning experience.”

Stream and Cortijo quickly realize Alicia has too many problems for student trainees to take on so Alicia will become Cortijo’s patient at one of her offices in Harlem or the Bronx.

That’s one less patient for the free clinic, though there are plenty of others in line behind her.

For Stream, there’s a satisfying difference between treating patients at the flagship NYU hospital and at the free clinic.

“Here, a patient may not have seen a doctor in the past 10 years. Patients may not have ever have seen a doctor,” she says. “While they’re here I want to figure out what’s wrong and how I can help them the most because we don’t know when they’re going to see a doctor again.”

Stream is in her last semester. After that, whether she keeps seeing uninsured patients will depend on where she does her residency and where sets up shop.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.