AIM's Imaging Cost and Quality Program Featured on Politico.com
Wellpoint to help patients compare price info
The following article ran on Politico.com on August 17, 2011
8/17/11 1:19 PM EDT By Brett Norman www.Politico.com
Private health insurer Wellpoint is integrating pricing and quality-of-care information into its consumer Web and mobile sites to encourage patients to find the best price for the treatment they need, instead of using the providers recommended by their doctors.
"When doctors prescribe a name brand drug, and patients know it's going to cost them more than the generic, they will have that conversation with the physician," said Perry Pogany, vice president of account management for Anthem National Accounts, a Wellpoint company that handles large accounts with the parent company's 14 Blue Cross Blue Shield Association plans.
"We want to make the information available so patients can have that conversation about knee replacements and MRIs, too," Perry said.
For years, insurance giants such as Wellpoint and UnitedHealth Group have offered online applications that allow patients to compare costs, but at least in the case of Wellpoint, the applications haven't gotten much use. "We built it, but they didn't come," Pogany said.
Beginning in September, Wellpoint, which covers about 34 million people nationwide, will introduce an overhauled physician directory, the most trafficked location on the health plans' sites with about 2 million visitors a month, said Meg Rush, the company's vice president of consumer experience and e-marketing.
A smartphone application for the directory will be launched shortly after. Then, in November, Wellpoint says it will integrate its currently scattered and underused cost and quality comparison Web tools, including a Zagat's Guide to doctors featuring patient reviews.
The directory will incorporate the Anthem Care Comparison application, which allows patients to look at quality measures and costs, based on the insurer's actual negotiated rates with providers, mostly for relatively high-volume, high-cost procedures, and the out-of-pocket hit to patients.
So-called price transparency has been touted for years as one lever that could tamp down soaring health costs by making the health industry operate more like a typical consumer market. Currently, insured patients are often shielded from actual treatment costs by the fixed co-pays and deductibles of their benefit plans.
"At the end of the day, what matters to consumers is the out-of-pocket costs," Pogany said.
One way to cut costs — and encourage patients into a more active shopping role — is by limiting the benefit for a procedure, such as an MRI, in a given market. Depending on how much of the annual deductible a consumer has paid, for instance, the patient's cost for getting that MRI from one provider instead or another can vary greatly.
"To use some hypothetical figures, say a patient can get an MRI for $700 at an outpatient facility, $900 at another and $2,100 at a hospital," Pogany said. "If the benefit pays $850, then they can choose whether they want to get the MRI for less than that or pay for the balance some other way."
For high-cost imaging services, in particular, Wellpoint has seen this work. Last December, Wellpoint launched a pilot project in Indianapolis and surrounding counties run by its subsidiary, American Imaging Management, a radiology vendor.
When doctors' offices requested approval for an imaging service at an expensive provider, AIM officials would list cheaper options in the market that rated equally well on self-reported quality measures developed by the company with input from various professional radiology societies.
If the doctors' office continued to recommend the more expensive facility, AIM would call the patient directly and lay out the options, Pogany said.
Studying the pilot's performance over four months, Wellpoint found that patients were redirected to less-expensive providers 11 percent of the time. The pilot, called the AIM Smart Shopper, will be expanded to four more metropolitan markets later this year and into the rest of the Anthem markets next year.
UnitedHealth is expanding its efforts in this area, too. For years, it has offered a Treatment Cost Estimator, which gives provider-specific estimates based on claims data for 90 surgeries and procedures in more than 400 localities.
Daryl Richard, UnitedHealth's vice president for public relations, wrote in an email that the company is redesigning the application now.
In the first quarter of next year it will launch a "significantly enhanced version, with more detailed and specific pricing as well as embedding quality data into the cost estimates that are given so consumers can assess quality as well as price," Richard wrote.
"I think this is part of a continuing trend by insurers and others in the health care system to get more usable information into the hands of consumers to make informed decisions with their health care providers before they become patients and need treatment," Coventry spokesman Matt Eyles said.
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For more information about Smart Shopper contact Ana Perez at pereza@americanimaging.net