Most consumers have little idea what their health care costs. Traditionally, those who got their health insurance from their employer have had no real reason to find out. But this is changing. Plans with higher deductibles have become the norm and, plainly put, consumers shoulder more of their health care costs. These consumers — our customers and neighbors — need constantly updated information as to what their financial responsibility will be. And, although interest grows in closing this knowledge gap, such health-care cost information has just not been readily available.
Sometimes, even if such data can be ferreted out, it approaches unbelievability. For example, in a study on hip replacement costs published online in February by the Journal of the American Medical Association, after five phone calls, researchers were only able to obtain prices from 85 percent of the hospitals contacted. For those who responded, prices were said to range from $11,000 to $126,000 to replace a single hip. Patient confusion and frustration blossom.
If we want consumers to make good health care decisions, we need to inform them with the best, most current data available.
We must show our members their real-time options, such as conveniently located providers, up-to-date actual costs and impartial quality ratings. Thus, Harvard Pilgrim will soon be launching a cost and quality calculator called Now iKnow — to answer these basic questions in a way that we know will be of enormous practical value for individual consumers.
Here’s how it works. In the event that my physician recommends an MRI of my back, I can use Now iKnow to find the facility that provides the best quality service at the lowest price. Once I log in to the cost calculator, it will indicate the benefits, deductible and out-of-pocket costs, specific to my own health plan. Now iKnow will give me the option of searching by specialist, condition or common types of care. I can indicate how far I am willing to travel to get the care. I will be able to compare several providers by what my actual costs would be, given my current deductible level and including both physician and facility fees. If I participate in a tiered or limited network, providers appropriate to those plans will be suggested. I can also see which local providers have been named to the Harvard Pilgrim Honor Roll for their performance in the top quartile on national quality benchmarks.
This depth of detail will be available for 1,000 common procedures — from maternity services to dermatology — including urinary tract infections, allergist visits and echocardiograms.
What will happen when consumers have cost and quality information so readily available? We expect that they will act on it just as they do with information supplied by leading consumer magazines and websites, i.e., the consumer’s choice will be heavily influenced by demonstrably reliable quality and price data. In short, we expect consumers will become much more engaged in their health care decisions.
Gaps in the health care quality and cost information available to consumers must be filled. Cost and quality calculators like Now iKnow are one way we can help consumers understand their options and make the best health care choices. And the more actual, up-to-date information they have, for the greatest number of procedures, the better.
The relevance of tools like these goes beyond our individual pocketbooks. In America, there is agreement across the political spectrum that we need more value and better quality for our health care expenditures. Knowledgeable and empowered consumers will play a critical role in achieving these goals, here in Maine and nationally. It will be a long journey from here to continually improving the quality and controlling the cost of health care in Maine. Actual transparency — the availability of understandable, reliable, actionable information — is an essential first step.
Ed Kane is vice president of Harvard Pilgrim Health Care’s Maine branch.