 |
 |
 |
 |
 |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
|
|
|
| Please enter the story
number in the box obove you would like to immediately access |
|
|
|
|
 |
|
 |
|
 |
|
|
|
|
|
|
|
|
|
 |
 |
Massachusetts |
|
|
|
|
| Healthcarebluebook.com: Delivering Fair, Upfront Pricing for Patients and Providers |
|
|
Story Number is
:
060609100
|
|
|
|
|
| |
 |
|
Provided |
|
|
|
|
|
The idea for the Healthcare Blue Book, a free pricing guide for consumers, came from personal experience as so many new services often do. A few years ago I went to have my annual physical and lab tests. I was charged a “discounted amount” for the lab test that was more than 10 times what I knew to be a reasonable rate.
When I called to question the rate the provider told me, “That’s too bad, our charge is our charge.”
I realized if I could get taken advantage of like that, and I’m a very informed consumer, those who don’t know as much as I do must overpay all the time. I saw a huge opportunity to educate consumers about how to get fair prices for healthcare services. That’s when the idea for the Healthcare Blue Book was born. I brought together a group of health executives I knew to build a national pricing database that consumers could access for free. The final service goes much beyond pricing. We like to say that www.healthcarebluebook.com ensures people get the right care, from the right provider, at the right price.
Throughout most of my twenty plus years as a physician, I’ve been an advocate for high quality care at a fair price. In the early 1990s, I was director of managed care at Duke University Medical Center which is where I gained insight into managed care contracting. I soon discovered how much prices may vary for the exact same service based upon which insurance company a patient has or which provider they visit. Following that experience, I built a company called CareSteps which promoted quality healthcare by giving patients access to evidence-based medical information and educating them about the kind of care they needed for common, chronic illnesses.
Focusing Patients and Providers on Value
For the past two decades, most consumers have been in a managed care plan where they go to the doctor or hospital and pay only a small co-pay. They haven’t needed to consider what a procedure or visit actually costs.
But in today’s economic environment, consumers are paying more out-of-pocket for care than ever before. According to Mercer, the average health plan deductible is $1,000 and rising. New healthcare products, such as consumer directed health plans with health savings accounts, save consumers money on monthly premiums but deductibles can be thousands of dollars. Consumers must learn to research what healthcare costs and how they can find affordable care to successfully use these products.
Providers are now well aware of the impact consumerism is having on their business. Hospitals’ financial health is often dependent upon lowering patient bad debt. Physician practices are also at risk.
Looking back on the landscape, it is easy to see that providers have given some of their best prices to health plans and this has worked against them. Health plans have been slow to pay, deny claims outright, and drive up administrative costs. More importantly, the provider discounts force the employers to use health plans as middlemen. With the health plan taking on this role, providers often don’t make the final decision on what type of care a patient should receive. The end result is that providers often don’t have a direct or independent relationship with employers and patients.
Providers need to have more integrity in the pricing of their services. Why would they give better pricing to less desirable health plans? Some of their best customers are willing to pay cash up front. Why should these patients be charged so much more? As we look forward, successful providers will realize that the most important thing is offering good value which amounts to quality care at reasonable prices. Part of that value will be fair, upfront pricing of services.
Building the Healthcare Blue Book
It took us two years to build the Healthcarebluebook.com database and platform. The data we use comes from national claims data and managed care contracting methodologies. Once we had the architecture in place, we beta tested it last fall and officially launched in January of 2009.
In order to be successful, we had to develop a tool that was consumer friendly. We drew upon our years of experience with consumer health education in order to make decisions about how to present services in a way that makes sense for the consumer. You can literally go onto our site, type in the kind of procedure or test you need, add your zip code, and it will give you a price for the costs associated with the service.
We also knew our tool needed to be better than those offered by some health plans. Health plan pricing tools are often hard to use and don’t cover a broad spectrum of healthcare services. In addition, they are only available to members of a specific health plan. The Healthcare Blue Book is available to all consumers and we welcome all providers to list their services. Unlike health plans, the Healthcare Blue Book does not negotiate or dictate provider rates. We only ask that providers disclose fair, upfront prices to consumers; the specific rates are determined solely by the provider.
So far, the majority of feedback is very positive. There is a great deal of interest from the healthcare community and corporations, as well as consumers, in our tool. We will continue to work closely with consumers to adapt our site to meet their needs. For example, if someone cannot find a procedure or test on our site, we will personally research it for them and provide the information. Then we add it to our site.
A Customized Product for Companies
The Healthcare Blue Book also has an employer application so that companies can customize it to their provider network’s pricing which makes it easier for employees to determine what they should be paying in and out of network.
Our research shows enormous variation in pricing for individual services in provider networks within a single health plan. For example, one company we reviewed had 15,000 patients in one of its markets in Texas. For many common services, the in-network price for a particular service varied by 300% to 600% depending on which provider was visited.
Hospitals can also benefit from the Healthcare Blue Book when working with local employers. Typically employers will use a health plan with a network that includes most of the local hospitals. Yet, the health plans do little to promote specific hospitals. If a hospital provides a good value, the hospital can use the Healthcare Blue Book to promote their services to those employers and their employees.
Next Steps
Healthcarebluebook.com is a work in progress and we are continually refining it to meet the needs of providers and patients. We recognize that it will take time for consumers to change their behavior and learn to consider the price and quality of healthcare. Right now, some mistakenly equate a high price tag with high quality. Our goal is to make sure they fully understand both the quality and the price of their care.
(Dr. Jeffrey Rice is CEO of Healthcarebluebook.com, a free web site that provides pricing information to consumers. He has over 20 years of clinical, information technology and executive management experience within academic medical institutions, national health plans, disease management organizations and healthcare IT solution consulting firms).
|
|
|
| |
|
|