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Cost comparison: Insurers eager to talk price points

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Whether it's an MRI, knee surgery or another medical procedure, consumers are turning to the Web to research and price shop for health care providers.

Insurers have taken notice — and they're lending a hand to their members with tools such as rating systems and cost estimators.

Experts say the popularity of online health care shopping is fueled by the spread of high-deductible health plans, in which the premiums are lower but members have to pay a bigger share of their medical bills.

Once members log on, they quickly discover that the prices doctors, hospitals and outpatient facilities charge for the same procedure vary tremendously — and that the providers with the highest quality ratings aren't necessarily the most expensive.

For instance, a search for a colonoscopy in the Parsippany area finds the costs vary considerably — from under $3,000 to nearly $6,000 — in part because there's a huge price differential among hospitals and ambulatory care centers.

That's led insurers to create rating tools such as the Cigna Care Designation, which appears when searching on Cigna's online shopping portal. Providers who have earned that status are pushed to the top of the list, meaning they've gotten high marks for both clinical quality and cost.

Marie Jinks, director of eBusiness for Cigna, said the insurer makes evaluations based on “many quality measures and … the overall cost efficiency of the doctors.” Cigna compiles quality rankings from several medical data sources, including mortality data for surgeons, and providers are evaluated on their adherence to evidence-based medical standards.

“We look at the doctor's patients to see if they're getting industry-standard care for that diagnosis,” Jinks said. “Are they getting the right tests? Are they on the right medication?”

Cigna said its Web portal now gets more than 1 million visitors each month — and more than 250,000 are drilling down to find the cost and quality details about doctors and health care facilities.

Scott Evelyn, Cigna's president for New Jersey, said that before the advent of online price-comparison tools, most consumers didn't know how much a medical procedure cost until after the fact, when they got the “explanation of benefits” statement in the mail from their insurer. But Cigna and other insurers now give their members a cost estimate tailored to their health plan, detailing how much the member will have to pay out of pocket.

“We wanted to give our members the ability to see this on the front end,” Evelyn said.

Aetna, which has been offering online shopping tools to its members for more than a decade, rolled out the newest version of its Member Payment Estimator in 2010.

“If we are going to have an impact on costs, we have to have our members purchase health care the way they purchase other goods and services,” said John Lawrence, Aetna president for New Jersey. That means “understanding what those costs are and making a decision around: 'Do I want to pay X, or do I want to pay Y for those services?'”

According to Aetna, traffic on the site rose more than 50 percent last year.

Lawrence stressed that members use the website for not just price shopping but researching quality, too.

Efforts to convey the value of the tools dovetail with the rise of new reimbursement contracts for hospitals and doctors, Lawrence said. Those providers are increasingly being rewarded for delivering better patient outcomes, rather than the traditional fee-for-service system, which pays providers regardless of their impact on the health of their patients.

That has fueled a push to inform members about those tools. John Verga, vice president of UnitedHealthcare, said about a quarter of its members use its online treatment cost estimator — and “that increases dramatically when employers help us advertise it to their employees.”

The challenge, Verga said, is “getting people to understand what's in it for them.” There's less enthusiasm for shopping around if the employee's health plan just imposes a $35 copay, with insurance picking up the rest. But for members with high deductibles, “it's more meaningful to me because the first $1,000 is my money, and I want to spend that in the most efficient manner possible.”

UnitedHealthcare has also rolled out its online tools for mobile devices, Verga said. That allows members to find out how much their medical care will cost them in the doctor's office or how much a drug will cost before they get to the pharmacy.

As a rating system, the insurer has identified “premium designation” physicians who score high on both quality and cost efficiency, finding that costs are 14 percent less when members use those physicians.

Horizon Blue Cross Blue Shield of New Jersey, the state's largest insurer, also provides a treatment cost estimator, which allows members to find the medical practices that score high on cost and quality.

Horizon's website guides members to “patient-centered medical homes” — or practices that have achieved a standard for clinical quality and efficiency. Spokesman Tom Vincz said Horizon's network currently has 2,800 PCMH practices, which provide care to 500,000 of its members.

E-mail to: beth@njbiz.com

 

It pays to price check
When Marie Jinks of Cigna searched for knee replacement surgery, she found the cost of the procedure ranged from $5,900 to $8,800 at a midsized medical center and from $27,000 to $34,000 at an academic medical center.

In New Jersey, one hospital may charge 30 percent more than another nearby hospital for the same procedure, according to Cigna executives, and one imaging center may be 20 times as expensive as another.

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Beth Fitzgerald

Beth Fitzgerald

Beth Fitzgerald reports on health care, small business and higher education. She joined NJBIZ in 2008 after a 34-year career at the Star-Ledger and has been reporting on business in New Jersey since 1978. Her email is beth@njbiz.com and she is @bethfitzgerald8 on Twitter.

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