NASHVILLE, Tenn.--Marathon Health and Healthcarebluebook.com today announced a co-marketing agreement to bring new consumer education and healthcare price transparency tools to employers with consumer directed health plans (CDHP) or high deductible health plans (HDHP).
The joint offering extends Marathon Health’s onsite clinic capabilities by helping employees with significant out of pocket expenses make informed, cost conscious decisions on treatment. Both onsite clinicians and employees will have access to the Healthcare Blue Book’s education and healthcare price transparency tool. Marathon Health clinic patients can access the Blue Book tool directly from the Marathon eHealth Portal, or work with their onsite clinician to consider treatment options, understand out of pocket costs, and make smarter, more affordable treatment choices when seeking care outside the clinic setting.
“Price shopping for healthcare services can be time consuming and frustrating,” said Marathon Health CEO Jerry Ford. “Our co-marketing agreement with Healthcare Blue Book will help us provide a virtual ‘safety net’ for the employees with high deductible plans who require greater access to cost and care details. This addition to our technology platform will ensure our patients have the information they need when making care decisions.”
The relationship enhances Marathon Health’s value proposition for employers who offer CDHPs by bringing timely consumer decision support to the point of care. The joint offering fills a recognized gap in employers’ consumer tool set, and helps both employee and employer save money through better use of their existing provider options.
“Marathon Health and Healthcarebluebook.com are innovative companies creating new models for delivering high-quality healthcare at a fair price,” said Healthcarebluebook.com CEO, Dr. Jeffrey Rice. “Joining forces will help us create systems that can benefit employers and employees through improved access to high-quality, cost-effective care.”
About Marathon Health
Marathon Health of Colchester, VT, offers a proven solution for helping employers reduce the total cost of healthcare. The Marathon Health approach integrates the best practices of onsite primary care, health assessment with risk identification, coaching and advocacy, and disease management for high cost chronic conditions. Marathon Health supports its unique model with an eHealth Portal delivering medical content, interactive diet and fitness tools, a personal health record, and an electronic medical record to manage care. www.marathon-health.com.
About the Healthcare Blue Book
Healthcarebluebook.com, headquartered in Nashville, TN, is a healthcare pricing tool that helps consumers and companies determine what fair prices are for healthcare services and treatments in their markets. The www.healthcarebluebook.com web site can be customized to employer needs by offering information that allows employees to identify lower cost and high quality providers within their existing employer-sponsored health plan.
Tuesday, January 12, 2010
Thursday, December 17, 2009
NJ Hospital Charges Top the Charts
A recent article by Susan Livio highlights the billing practices of NJ hospitals. Such practices have them billing a lot more than many other hospitals in other states.
National health care economist Graham Atkinson said concerns are well-founded. New Jersey hospital charges are 4.1 times higher than what it costs to treat patients — far exceeding the national average of 2.8 times above cost, he said, based on American Hospital Association data.
A report put out by the New Jersey Health Care Quality Institute shows the impact of the high prices and the state's policy on billing.
While state laws insulate some patients from the impact of hospitals' full charges, many patients are still paying way too much. For example, if a single patient makes $32,000/year and receives an appendectomy at Elmer Hospital, he would pay just $4,797. However if that same patient happened to make $52,150/year the price would jump to over $43,000. So if one patient makes $20,000 more than another one, then they would pay over $38,000 more for their care (or 9 times more).
By comparison the Healthcare Blue Book has a fair price for the procedure of approximately $12,000.
Given the high prices charged by many NJ hospitals, patients need to be particularly careful when seeking hospital care.
National health care economist Graham Atkinson said concerns are well-founded. New Jersey hospital charges are 4.1 times higher than what it costs to treat patients — far exceeding the national average of 2.8 times above cost, he said, based on American Hospital Association data.
A report put out by the New Jersey Health Care Quality Institute shows the impact of the high prices and the state's policy on billing.
While state laws insulate some patients from the impact of hospitals' full charges, many patients are still paying way too much. For example, if a single patient makes $32,000/year and receives an appendectomy at Elmer Hospital, he would pay just $4,797. However if that same patient happened to make $52,150/year the price would jump to over $43,000. So if one patient makes $20,000 more than another one, then they would pay over $38,000 more for their care (or 9 times more).
By comparison the Healthcare Blue Book has a fair price for the procedure of approximately $12,000.
Given the high prices charged by many NJ hospitals, patients need to be particularly careful when seeking hospital care.
Saturday, December 12, 2009
Everything Old Is New Again
Blue Cross Blue Shield of Massachusetts Inc. recently announced a deal covering 60,000 members of the Caritas Christi Health Care system. The new payment arrangement is touted as one of the country's largest experiments in fundamentally changing the way doctors and hospitals are paid.
The contract includes a so-called global payment system in which the hospitals will be paid fixed amounts based on the estimated annual costs of patients’ care instead of the fee-for-service system in which providers bill insurers for individual visits and procedures. It also includes incentives to improve the quality and affordability of care.
Not to take anything away from a health plan attempting to address the ills of fee for service incentives, but the new system has an old name: capitation.
Capitation payment systems have been used in many forms for many years. However capitation has not become the predominant payment system in US healthcare because it shifts the provider incentives from doing too much to potentially doing too little. Providers want to deliver good care and be compensated in a reasonable manner. Asking providers to be the arbiters of the value of treatments puts them in an uncomfortable, if not impossible, position.
Patients should decide the value of treatment options. Different patients will make different decisions.
To actually make a fundamental change the current healthcare system, health plans need to support pricing transparency and plan designs that let patients have some 'skin in the game' as they make decisions.
Related articles:
WSJ
Boston.com
The contract includes a so-called global payment system in which the hospitals will be paid fixed amounts based on the estimated annual costs of patients’ care instead of the fee-for-service system in which providers bill insurers for individual visits and procedures. It also includes incentives to improve the quality and affordability of care.
Not to take anything away from a health plan attempting to address the ills of fee for service incentives, but the new system has an old name: capitation.
Capitation payment systems have been used in many forms for many years. However capitation has not become the predominant payment system in US healthcare because it shifts the provider incentives from doing too much to potentially doing too little. Providers want to deliver good care and be compensated in a reasonable manner. Asking providers to be the arbiters of the value of treatments puts them in an uncomfortable, if not impossible, position.
Patients should decide the value of treatment options. Different patients will make different decisions.
To actually make a fundamental change the current healthcare system, health plans need to support pricing transparency and plan designs that let patients have some 'skin in the game' as they make decisions.
Related articles:
WSJ
Boston.com
Wednesday, November 18, 2009
Facility Surcharge for Doctor Visits
Consumers must always be careful of hidden fees and unexpected charges when purchasing healthcare services. A new version of hidden fees has been gaining attention the past several months: Called "provider-based billing", there is a rule that allows hospitals that own physician practices and outpatient clinics that meet certain federal requirements to bill separately for the facility as well as for physician services as long as the bill all patients for it.
What does this mean? If you go to your doctor for an office visit, you expect to pay for the office visit. If you happen to go to a doctor that is owned by a hospital, then you may also be charged a "facility charge". According to Kaiser Health News facility charges can range from $25 to hundreds of dollars. Unaware consumers can be in for quite a surprise.
One of the troubling issues that results is the fact that this hidden billing has its largest impact on uninsured and self-paying patients. While the Medicare program allows hospital owned physicians to charge the facility fee, Medicare typically dictates a below market fee schedule for the physician services. Private insurers can also negotiate set rates that eliminate the facility fees. Self-pay patients are left paying the full amount of the physician bill plus the facility fees.
Given the recent increase in physicians joining hospitals as owned practices, the issue of facility fees is likely to grow.
For other reports on this see:
Cleveland Plain Dealer
USA Today
What does this mean? If you go to your doctor for an office visit, you expect to pay for the office visit. If you happen to go to a doctor that is owned by a hospital, then you may also be charged a "facility charge". According to Kaiser Health News facility charges can range from $25 to hundreds of dollars. Unaware consumers can be in for quite a surprise.
One of the troubling issues that results is the fact that this hidden billing has its largest impact on uninsured and self-paying patients. While the Medicare program allows hospital owned physicians to charge the facility fee, Medicare typically dictates a below market fee schedule for the physician services. Private insurers can also negotiate set rates that eliminate the facility fees. Self-pay patients are left paying the full amount of the physician bill plus the facility fees.
Given the recent increase in physicians joining hospitals as owned practices, the issue of facility fees is likely to grow.
For other reports on this see:
Cleveland Plain Dealer
USA Today
Sunday, November 8, 2009
$100M Healthcare Pricing Database
We have been following the NY attorney general's cases against Ingenix and large health insurance companies. The attorney general recently announces where the $100M in fines will go and what they intend to do with the healthcare data.
They will create a new Non Profit entity called FAIR Health that will be centered at Syracuse University. Other NY universities will share in the money and collaborate on the project.
FAIR Health will ultimately offer pricing information to consumers on a new website they intend to create. It should help consumers understand typical Insurance company reimbursement for out-of-network care. They hope to have the website up within one year.
You can view the attorney general announcing FAIR Health here.
They will create a new Non Profit entity called FAIR Health that will be centered at Syracuse University. Other NY universities will share in the money and collaborate on the project.
FAIR Health will ultimately offer pricing information to consumers on a new website they intend to create. It should help consumers understand typical Insurance company reimbursement for out-of-network care. They hope to have the website up within one year.
You can view the attorney general announcing FAIR Health here.
Wednesday, October 21, 2009
Public Option To Have Pricing Subsidy
Back in July we got a preview of the difficult situation of creating a Public Option that "competes fairly" in the market versus the hint that the Public Option might pay doctors below market rates.
Today the Washington Post reports that the House is planning a reconciled bill that "would include a government-run insurance plan that pays providers at rates tied to Medicare." Medicare rates are well below commercial market rates for most healthcare services.
This development is unlikely to promote pricing transparency. Medicare's current payment system sets most physician fees at a similar level which could foster transparency. However, it is very difficult for patients to determine what the specific fees will be before they receive care. This difficulty arises from complicated geographic adjustments and the fact that care levels, and therefore pricing, are generally determined after the care is provided.
In addition, Medicare's rules provide different payments to providers based upon place of service and many other factors. If you have a service performed at one hospital you will likely pay a different rate than if you had used the hospital across town. Have the service performed at an out patient facility and it could be much less expensive.
If consumers don't know what healthcare costs before they get treatment, it is very unlikely they will be able to help get more value for all the dollars they spend. Let's hope that whatever shape the final health reform bill takes that it will at least bring more transparency to the consumer.
Today the Washington Post reports that the House is planning a reconciled bill that "would include a government-run insurance plan that pays providers at rates tied to Medicare." Medicare rates are well below commercial market rates for most healthcare services.
This development is unlikely to promote pricing transparency. Medicare's current payment system sets most physician fees at a similar level which could foster transparency. However, it is very difficult for patients to determine what the specific fees will be before they receive care. This difficulty arises from complicated geographic adjustments and the fact that care levels, and therefore pricing, are generally determined after the care is provided.
In addition, Medicare's rules provide different payments to providers based upon place of service and many other factors. If you have a service performed at one hospital you will likely pay a different rate than if you had used the hospital across town. Have the service performed at an out patient facility and it could be much less expensive.
If consumers don't know what healthcare costs before they get treatment, it is very unlikely they will be able to help get more value for all the dollars they spend. Let's hope that whatever shape the final health reform bill takes that it will at least bring more transparency to the consumer.
Wednesday, October 7, 2009
FeelingFlu.com
It is hard to read the paper or watch the news without hearing something about the H1N1 flu (also called swine flu). But what should patients do? how can they understand their symptoms? Should they try to get the vaccine early on?
Now there is a really nice website devoted to helping patients understand swine flu and more importantly what they need to do. The site is found at feelingflu.com.
It is sponsored by A.D.A.M. who has a great reputation for providing consumer health information. This new website has a key feature that allows individuals to take a free online assessment. According to A.D.A.M. the proprietary, interactive tool uses a “self-triage” branching logic system to assess the individual’s symptoms and other information and then provides information about the most appropriate course and timing for treatment.
I encourage you to check out feelingflu.com
Now there is a really nice website devoted to helping patients understand swine flu and more importantly what they need to do. The site is found at feelingflu.com.
It is sponsored by A.D.A.M. who has a great reputation for providing consumer health information. This new website has a key feature that allows individuals to take a free online assessment. According to A.D.A.M. the proprietary, interactive tool uses a “self-triage” branching logic system to assess the individual’s symptoms and other information and then provides information about the most appropriate course and timing for treatment.
I encourage you to check out feelingflu.com
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