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Thursday, June 07, 2012

Controlling Health Care Cost - United Health Care Helps Beneficiaries Choose,0,5278281.story
"The old system was based on medical claims paid in the past. MyHealthcare Cost Estimator allows customers to estimate the costs of more than 100 common procedures and treatments, the company said. The service, rather than making reference to old medical claims, uses the insurer's actual contracted rates with doctors and hospitals in 47 markets, including Connecticut."

Health care costs must stop climbing at above the inflation rate, regardless of how the Affordability reform (HCA) law is implemented after the Supreme Court rules on challenges brought by a coalition of states that don't want to comply.

One way to control costs is to provide consumers with information they can use to shop for their health care. Consumers routinely shop for the best quality and cost for over the counter drugs (OTC) and eyeglasses, so, why not health care? 

Cost information for consumers is available because it's being collected in real time. Insurance companies have the information, but very few are willing to share it because they negotiate rates that bring profits to their businesses. Moreover, even publicly available information is difficult for ordinary people to understand.

Health care consumers, particularly those electing surgery for high volume procedures, likely have no idea their insurance companies have contracts with their providers for how much the insurer will pay.  In other words, regardless of how much a certain procedure (for example, gall bladder surgery) might cost, the fact is, the insurance company has a discounted contract rate already negotiated for the procedure, before the patient ever sees the surgeon or enters the hospital. This contract rate usually includes routine pre-operative work, the procedure itself and post-operative follow up.  

From the provider's point of view, the negotiated discount contract rate is compensated by the volume of business referred through the insurance company's network. For this reason, people who live in rural areas like Northern Maine might prefer to obtain high volume procedures like cardiac bypass surgeries in Boston, if their insurance carriers could compensate them for going to a provider who guarantees the contract rate through reducing co-pays for the patients.

So, why can't the patient, who ultimately pays all the cost through insurance premiums and co-pays, be given the information about these discounted contracts?  Health care consumers able to select a provider based on knowing the quality and cost for procedures will eventually bring down the cost of health care for everyone, because providers would be more sensitive to how their costs and outcomes compare.  

My six years experience on the board of the Maine Health Data Organization (MHDO) educated me about how health care cost and utilization data are publicly available. What's needed are reports that ordinary people can read.

Beneficiaries of United Health Care are now provided this cost/quality comparison as explained in their blog - but you need to be a beneficiary of the company to access the data.

As opposed to insurers who typically use data for proprietary purposes, suppose health care providers published their own data so consumers could do comparisons?  

For example, for hernia repair, a hospital or surgeon could update a report describing the number of procedures done at their facility over the past 5 years, what the outcomes were (infection rates  or unexpected mortality) and the average procedure costs.

My experience as a nurse assures me the consumers prefer to receive elective procedures from providers who are close to where they live.  So, the ultimate benefit of publishing costs and quality of care by procedure would raise the standard of care for everyone, while controlling costs for consumers who will demand value from their local providers.

Controlling the spiraling cost of health care can happen when consumers are empowered to evaluate the cost and quality of their  provider.  United Health Care data should be available in easy to understand formats to everyone. 

In other words, health care data is collected about YOU and should, therefore, be readily available when you need to shop and pay for services.



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