August 15, 2016 - Uncategorized
Crystal Clear Pricing for Health Care
Sticker price is extremely common.
We see the price clearly labeled when we purchase everything from homes and cars to our pack of gum at the gas station. Prices are upfront. Prices are transparent for most things in our lives. However, as patients, we have little to no knowledge about what is a good value in health care.
About 58% of individuals put off care due to the costs. Why? It’s not because the costs is too high. People still make other large purchases. It’s the unknown dollar figure. And that’s scary. There is no baseline about what is a, “fair” price for…anything.
Challenges to Transparent Pricing.
As patients’ financial responsibility increases, consumer pressure mounts to publish prices. It should be simple. Take the fees and put them online where everyone can access them. There are obvious benefits of ethical reporting, increased patient buy-in, and increased trust between stakeholders. Here are a few things providers and organizations face with transparent pricing:
It’s difficult to initially diagnose all of the services (including appointments and test) a patient will ever need.
Let’s think about this for a minute. You come in with nausea and a headache. You could have the flu, generalized anxiety, cancer, labyrinthitis, etc. The doctor needs to ask questions, run tests, and narrow it down a bit. Plus, every single person is different. This makes a, “one size fits all” approach very difficult for diagnosing, treating, and planning the total costs associated with those services.
There are multiple different types of insurance plans. Different companies offer their own version of insurance plans—making them not directly comparable to another company. You cannot directly compare prices, because they are not the same thing.
There is no standard formatting model or formula for pricing.
There is no formula that takes into account a provider’s experience, the quality level, expertise, and the treatment to equal what the total cost should be. Patients have no way to know if price is an indicator of a better patient outcome or not.
Patients receive bills from multiple providers.
Let’s say Jane visits her doctor. While she is there, her doctor wants to run some lab tests. The nurse takes samples in office and then she is sent to another location for x-rays. Jane is expecting to get one bill from the person treating her—her doctor. Yet, she has a bill from her doctor, the lab, and the radiologist. Jane doesn’t know or understand if her bill from the doctor includes the other costs or if she is supposed to pay each bill. It’s a confusing scenario to type out…just think about how confused Jane is! It is difficult to determine the end price when changes arrive from multiple sources.
Contracts sometimes prevent health plans from letting providers know their negotiated rates.
Some insurance companies contract with other large companies to offer employee health plans at a discounted rate, because of the large amount of people joining its network. These rates may vary from company to company, so they are confidential. Confidentiality makes complete sense, except for everyone else affected by this contractual arrangement. Physicians, hospitals, and other health care organizations are, many times, obligated by the insurance company to accept the health plans, but are unaware how much they will be paid. Providers take a huge financial risk when treating patients with these plans. Increased risk for the business means? You guessed it. Higher prices.
Current Pricing Tools
While there are certainly difficulties with transparent pricing, providers and innovators alike are beginning to come up with some tools to improve the financial conversation between patients, doctors, and insurance providers. Here are some organizations meeting the challenges head on and how their tools are benefitting patients:
Aetna – Member Payment Estimator
Aetna is one of the largest insurance providers serving over 46.5 million people. It has always been dedicated to leading innovation in its field. They’ve been at the front of strategically solving problems for patients and providers—including being one of the first companies to lead price transparency starting in 2005.
Aetna’s Member Payment Estimator allows individuals in-network lookup comparative cost estimates while keeping them aware of their plan type and deductible.
Blue Cross Blue Shield – Doctor and Hospital Finder + Price Transparency Tool
As part of its efforts toward price transparency, Blue Cross Blue Shield Axis announced in September 2015 that it would be compiling 36 million records from providers for all of its companies.
BCBS members can use apps such as Doctor Finder and Hospital Finder to not only track their benefits or search for physicians, but they can also compare quality through patient reviews and physician profiles. One feature in Doctor Finder even includes average physician wait times.
Individuals wanting to search for in-network price comparisons will need to wait until the app is rolled out in their state, unless you live in North Carolina.
United Health Care – myPriceEstimator
United Health Care’s myHealthcare Cost Estimator offers a step-by-step approach to estimating prices for its members. Members can get a, “quick estimate” by syncing their plan and then searching condition key terms like, “back pain”. Then, members have access to a, “final estimate” after selecting the provider and/or facility for the treatment being received.
Medl.io – Common Cents
While Medl.io is not an insurance provider, it does offer a unique platform for patients and providers to have transparent pricing. This is the tool to use for providers wanting to improve patient satisfaction among existing patients. The software is a blend between a patient engagement, check-in, and payment tool in one.
Castlight – Health Benefits Platform
Castlight offers a different type of niche product. Their software is geared toward large companies wanting to increase their employee satisfaction and retention rates by offering a health benefits platform that is easy to use. The benefits platform includes all care aspects—medical, pharmacy, behavioral health, and dental.
Health Care Price Transparency Tool Chart
| AETNA | BCBS | UHC | MEDL.IO | Castlight | |
| Search in-network providers |
X |
X
|
X
|
X
|
X |
| Search out-of-network providers |
X
|
||||
| Fee schedule |
X
|
*X
|
X
|
X
|
|
| Search for pharmacies |
X
|
||||
| Estimates co-payments |
X
|
*X
|
X
|
X
|
X
|
| Estimates co-insurance |
X
|
*X
|
X
|
X
|
X
|
| Android app |
X
|
X
|
X
|
X
|
X
|
| iOS app |
X
|
X
|
X
|
X
|
X
|
| Search by condition and/or treatment |
X
|
X
|
X
|
X
|
|
| Takes into account patient’s insurance plan and remaining deductible |
X
|
X
|
X
|
X
|
X
|
| Out-of-pocket estimator |
X
|
X
|
X
|
X
|
|
| Patient reviews of providers |
X
|
X
|
|||
| Keeps track of health spending |
X
|
||||
| Provider contact information |
X
|
X
|
X
|
X
|
|
| Provider education and training information |
X
|
X
|
|||
| Average provider wait times |
X
|
||||
| Online appointment scheduling |
X
|
X
|
|||
| Educational information |
X
|
X
|
|||
| Accepting new patients, provider search |
X
|
||||
| Nearest hospital and/or urgent care search |
X
|
X
|
X
|
X
|
|
| Nearest physicians search |
X
|
X
|
X
|
X
|
|
| Provider quality ratings |
X
|
||||
| Nearest tests and/or imaging search |
X
|
X
|
|||
| Patient check-in from app |
X
|
||||
| Patient pay from app |
X
|
||||
| Patients can store medical info/health history in app |
X
|
||||
| Track insurance benefits metrics for multiple employees |
X
|
*Feature may not be available in all states
Conclusion
Transparency in pricing may not lead to consumer behavior changes or buying patterns. More likely, it will result in increased trust between the patient and provider since the relationship has been based on clear communication of all patient care aspects—including financial. Healthcare organizations should make efforts to increase transparency in pricing with their patients.
