There is an interesting article in the Tennessean on Nashville based healthcare start ups. See all the articles here.
We were pleased to be included.
Here is part of the story :
Healthcare Blue Book: Making the most of cost comparisons
By Getahn Ward • The Tennessean • May 17, 2009
For years, Kelley Blue Book has been a go-to source for car buyers and sellers who want to gauge the value of vehicles.
Dr. Jeffrey Rice and Bill Kampine hope their Healthcare Blue Book becomes the same type of resource for consumers seeking information on prices of competing health services.
At healthcarebluebook.com, consumers can compare “fair” cash prices that they would expect to pay out-of-pocket for a range of procedures and medical services within their ZIP codes. The company also targets employers with a customized version where employees can see what each provider gets paid and how they rate on quality. The idea is to help patients decide where to seek care.
“It’s to help consumers find the right care from the right provider at the right price,” said Kampine, a co-founder of Healthcare Blue Book.
Companies such as Healthcare Blue Book hope to ride growing interest in more transparency in health care.
Launched in January, Healthcare Blue Book is the latest startup venture for Rice and Kampine. They worked together at CareSteps, a company that’s now part of Healthways, which helped consumers understand their health risks and get care according to evidence-based guidelines.
Healthcare Blue Book gets its revenues through advertising on its free site, including from health-care providers. It charges employers a fee for its customized program.
Rice, the company’s chief executive officer, said the Web site is especially helpful for consumers with high deductibles or limited medical plans that place more of the financial responsibility on them. “If you don’t ask before you get your care, you may be charged three or four times more than the fair price,” he said.
Danielle Gilbert, a Nashville resident enrolled in a high-deductible plan recently used Healthcare Blue Book to get the fair market price for an MRI related to a leg injury. She has started calling around to find a provider willing to accept that price. “If you’re willing to spend a little extra time, it’s a great service,” Gilbert said.
Tuesday, May 19, 2009
Thursday, April 30, 2009
Health insurers may not be looking out for their employer customers
Health insurers are supposed to be managing care to make sure employers get a good value for the money they and their employees invest in healthcare. Unfortunately employers haven't seen many rate reductions the past two decades.
In fact, insurers make a percentage of the total spend. The larger the spend, the more they make. Some may be starting to wonder if insurers would ever make real efforts to shrink the pie?
Providers have given discounts to insurers, but don't see any real value in the 'service' insurers provide. Now comes a lawsuit by one provider system claiming that 'big insurance' is collaborating with 'big providers' to make sure the pie grows over time. Specifically, West Penn Allegheny Health System is accusing rival University of Pittsburgh Medical Center of conspiring with Highmark Inc. to destroy the region's No. 2 hospital network and drive it out of business. The concern is that collectively they could raise rates and pass the increases on to employers and patients. See article.
Is it possible that an insurer would put its on long-term profits ahead the employers interest? Even pay the providers a little more to 'grow the pie'? What do you think?
In fact, insurers make a percentage of the total spend. The larger the spend, the more they make. Some may be starting to wonder if insurers would ever make real efforts to shrink the pie?
Providers have given discounts to insurers, but don't see any real value in the 'service' insurers provide. Now comes a lawsuit by one provider system claiming that 'big insurance' is collaborating with 'big providers' to make sure the pie grows over time. Specifically, West Penn Allegheny Health System is accusing rival University of Pittsburgh Medical Center of conspiring with Highmark Inc. to destroy the region's No. 2 hospital network and drive it out of business. The concern is that collectively they could raise rates and pass the increases on to employers and patients. See article.
Is it possible that an insurer would put its on long-term profits ahead the employers interest? Even pay the providers a little more to 'grow the pie'? What do you think?
Tuesday, April 7, 2009
Consider Prices Before You Receive a Test, Treatment or Surgery
Employers offering higher deductible plans should help their employees learn to price healthcare services before they have them. Most employees don’t realize how much prices vary between different healthcare providers. Healthcarebluebook.com research found that the prices charged for the same test or treatment, even in the same market and within the same health plan, can vary by thousands of dollars. For example:
• In Chicago, IL prices for an MRI of the lumbar spine with contrast ranged from $500-$2661.00 among three hospitals and five imaging centers. (Healthcare Blue Book fair price is $522.00).
• In Washington, DC prices for an MRI of the right knee without contrast among five imaging centers ranged from $400-$1504 for the same test. (Healthcare Blue Book price is $912.00).
• In Nashville, TN prices for an MRI of the hip at five imaging centers ranged from $455 to $1302. (Healthcare Blue Book price – $507)
People are struggling to pay their medical bills and often suffer from sticker shock after they get the bill. Here are some steps that employers can share with their employees to help them get fair prices.
1. Ask the doctor to clearly explain the healthcare service you need. You should understand what you need done, why it’s important, and what options are available for where it can be performed. Don’t be afraid to ask your doctor, or another medical professional in that office, to be specific about the procedure or test and discuss it in plain language. There are also medical resources online such as WebMD and Mayo Clinic that will explain your treatment in less clinical terms.
2. Determine what a fair price is for your treatment or test in your market. Make sure you know how much services should cost. You can look up many healthcare services on the free consumer website at www.healthcarebluebook.com. Even when you get care from in-network providers, the prices you will pay for the exact same service, test or treatment can vary by 300-500 percent. Many employees assume they will pay a fair price if they stay in-network. Unfortunately this is not the case. While it is generally best to use in-network providers, employees still need to compare quality and prices.
3. Find out how much your provider charges. When possible, you should always ask your provider how much your treatment will cost before you receive care. Make sure to let your provider know which insurance company and plan type you have so he or she gives you the correct price. In some cases, you may have to call your insurance company to get a price. If your provider offers a reasonable price compared to the Healthcare Blue Book fair price, then you can be confident you are getting a good value. If their price is much higher than the fair price, then you may need to consider other options.
4. Compare prices from several providers. If you are uncomfortable with the value offered by your first provider, compare prices with other providers. Always start with in-network providers if you have a provider network. Call provider offices and request the price for the service. It is generally best to compare prices from 3 to 5 providers. And remember to consider different types of providers that can provide your service.
For example, if you need an MRI make sure to check prices at out-patient imaging centers. You may find a high quality center that charges $1000 to $2000 less than the high cost centers. If you need surgery, you may be able to have it performed at an Ambulatory Surgery Center (ASC) which can also save you as much as 50%. Fortunately, comparing prices usually only takes a few phone calls.
5. Get the agreed upon price in writing. If you are using out-of-network providers or if your provider quoted you a price that is different from its plan agreement, you should get a copy of the agreed upon charges in writing. This will eliminate problems that can arise if you receive an incorrect bill.
Companies of all sizes are struggling under the burden of skyrocketing healthcare costs. Consumer directed health plans (CDHP) and high deductible plans (HDHP) with health savings accounts (HSA) can save employers money but also require employees to be smart consumers. Employers can help their employees most by providing the tools they need to get fair prices.
• In Chicago, IL prices for an MRI of the lumbar spine with contrast ranged from $500-$2661.00 among three hospitals and five imaging centers. (Healthcare Blue Book fair price is $522.00).
• In Washington, DC prices for an MRI of the right knee without contrast among five imaging centers ranged from $400-$1504 for the same test. (Healthcare Blue Book price is $912.00).
• In Nashville, TN prices for an MRI of the hip at five imaging centers ranged from $455 to $1302. (Healthcare Blue Book price – $507)
People are struggling to pay their medical bills and often suffer from sticker shock after they get the bill. Here are some steps that employers can share with their employees to help them get fair prices.
1. Ask the doctor to clearly explain the healthcare service you need. You should understand what you need done, why it’s important, and what options are available for where it can be performed. Don’t be afraid to ask your doctor, or another medical professional in that office, to be specific about the procedure or test and discuss it in plain language. There are also medical resources online such as WebMD and Mayo Clinic that will explain your treatment in less clinical terms.
2. Determine what a fair price is for your treatment or test in your market. Make sure you know how much services should cost. You can look up many healthcare services on the free consumer website at www.healthcarebluebook.com. Even when you get care from in-network providers, the prices you will pay for the exact same service, test or treatment can vary by 300-500 percent. Many employees assume they will pay a fair price if they stay in-network. Unfortunately this is not the case. While it is generally best to use in-network providers, employees still need to compare quality and prices.
3. Find out how much your provider charges. When possible, you should always ask your provider how much your treatment will cost before you receive care. Make sure to let your provider know which insurance company and plan type you have so he or she gives you the correct price. In some cases, you may have to call your insurance company to get a price. If your provider offers a reasonable price compared to the Healthcare Blue Book fair price, then you can be confident you are getting a good value. If their price is much higher than the fair price, then you may need to consider other options.
4. Compare prices from several providers. If you are uncomfortable with the value offered by your first provider, compare prices with other providers. Always start with in-network providers if you have a provider network. Call provider offices and request the price for the service. It is generally best to compare prices from 3 to 5 providers. And remember to consider different types of providers that can provide your service.
For example, if you need an MRI make sure to check prices at out-patient imaging centers. You may find a high quality center that charges $1000 to $2000 less than the high cost centers. If you need surgery, you may be able to have it performed at an Ambulatory Surgery Center (ASC) which can also save you as much as 50%. Fortunately, comparing prices usually only takes a few phone calls.
5. Get the agreed upon price in writing. If you are using out-of-network providers or if your provider quoted you a price that is different from its plan agreement, you should get a copy of the agreed upon charges in writing. This will eliminate problems that can arise if you receive an incorrect bill.
Companies of all sizes are struggling under the burden of skyrocketing healthcare costs. Consumer directed health plans (CDHP) and high deductible plans (HDHP) with health savings accounts (HSA) can save employers money but also require employees to be smart consumers. Employers can help their employees most by providing the tools they need to get fair prices.
Tuesday, March 31, 2009
Consumers Need Independent Healthcare Pricing Information
Consumers continue to need independent sources for healthcare pricing information and the need is growing. Consumers are paying more and more out of pocket for their own care with increasing deductibles, co-pays, and co-insurance; Consumer Driven Health Plans (CDHP) plans and Health Savings Accounts (HSA); and the growing ranks of uninsured as the economy weakens. The healthcare industry continues to fail the consumer in providing pricing transparency. And recently, we see more evidence that some healthcare companies are crossing the line to actively disadvantage those paying for care.
The first example comes from the pharmaceutical industry as a settlement was announced between Baxter Health Corporation and the State of Wisconsin. Baxter allegedly reported average wholesale prices (“AWPs”) to pricing compendia for identified drugs that were grossly inflated and did not reflect the actual average wholesale prices. The inflated reports lead to increased costs for those purchasing the drugs. Baxter settled the lawsuit for a total amount of $1,050,000.
The settlement can be found here. Thirty five other pharmaceutical manufacturers have been charged as well.
The second example comes from California where The California Medical Association, American Medical Association and individual physicians have filed a lawsuit against WellPoint. The suit alleges that WellPoint colluded with Ingenix, a unit of United Health Group, on a price-fixing scheme that relied on an obscure database to set artificially low reimbursement rates for out-of-network care. "Health insurers are data manipulating to set rates artificially low, forcing patients to pay more than they bargained for when they go to a doctor of their choice," said Dr. Dev GnanaDev, CMA president.
Patients need to be careful consumers of the healthcare system. Prices vary a lot, even when patients stay in their insurer's network. When possible, patients should always ask about price before they get services. Then make sure the price you are offered is reasonable and fair. You can find fair prices for many healthcare services at the free consumer website: www.healthcarebluebook.com.
The first example comes from the pharmaceutical industry as a settlement was announced between Baxter Health Corporation and the State of Wisconsin. Baxter allegedly reported average wholesale prices (“AWPs”) to pricing compendia for identified drugs that were grossly inflated and did not reflect the actual average wholesale prices. The inflated reports lead to increased costs for those purchasing the drugs. Baxter settled the lawsuit for a total amount of $1,050,000.
The settlement can be found here. Thirty five other pharmaceutical manufacturers have been charged as well.
The second example comes from California where The California Medical Association, American Medical Association and individual physicians have filed a lawsuit against WellPoint. The suit alleges that WellPoint colluded with Ingenix, a unit of United Health Group, on a price-fixing scheme that relied on an obscure database to set artificially low reimbursement rates for out-of-network care. "Health insurers are data manipulating to set rates artificially low, forcing patients to pay more than they bargained for when they go to a doctor of their choice," said Dr. Dev GnanaDev, CMA president.
Patients need to be careful consumers of the healthcare system. Prices vary a lot, even when patients stay in their insurer's network. When possible, patients should always ask about price before they get services. Then make sure the price you are offered is reasonable and fair. You can find fair prices for many healthcare services at the free consumer website: www.healthcarebluebook.com.
Tuesday, March 3, 2009
The Cost and Quality of Imaging
The New York Times raises awareness of the variation in quality for imaging studies such as CT and MRI; however they miss some of the most important issues to improve quality and costs.
First, Insurers don't pay the same price for imaging regardless of where it is done. Most insurers pay different providers different prices, even in the same market for the same services. This is a fact that hurts even those patients with insurance. Pricing of MRIs and other tests even within a single market and for a single insurer usually vary a lot. We recently helped a patient schedule an MRI. The first imaging center wanted $2,500, by calling around we found a high-quality center that charged just under $500. This dropped the patients 20% coinsurance amount from $500 to $100.
Second, paying a higher price for your healthcare does not mean you are getting higher quality care. Often the opposite is the case. Many high volume centers that do it right the first time will also have lower costs for patients.
And most importantly, when patients don't ask about price they usually don't ask about quality either. When patients engage in choosing a provider they tend to ask about both cost and quality.
I suggest that any time you need to have a test, surgery, procedure, etc. you shop around. The Healthcare Blue Book can tell you what the fair price for a service is in your market. Then you can call several facilities in your area and ask what type of machine will be used, how old it is and what the cost is.
Just as consumers must ask questions about quality, they also need to ask questions about price.
First, Insurers don't pay the same price for imaging regardless of where it is done. Most insurers pay different providers different prices, even in the same market for the same services. This is a fact that hurts even those patients with insurance. Pricing of MRIs and other tests even within a single market and for a single insurer usually vary a lot. We recently helped a patient schedule an MRI. The first imaging center wanted $2,500, by calling around we found a high-quality center that charged just under $500. This dropped the patients 20% coinsurance amount from $500 to $100.
Second, paying a higher price for your healthcare does not mean you are getting higher quality care. Often the opposite is the case. Many high volume centers that do it right the first time will also have lower costs for patients.
And most importantly, when patients don't ask about price they usually don't ask about quality either. When patients engage in choosing a provider they tend to ask about both cost and quality.
I suggest that any time you need to have a test, surgery, procedure, etc. you shop around. The Healthcare Blue Book can tell you what the fair price for a service is in your market. Then you can call several facilities in your area and ask what type of machine will be used, how old it is and what the cost is.
Just as consumers must ask questions about quality, they also need to ask questions about price.
Sunday, February 15, 2009
Lawsuits may impact pricing transparency.
A crop of lawsuits highlights the difficulty of determining reasonable provider payment rates. Providers will always want higher reimbursements while insurance companies aim to pay the least amount possible. Unfortunately for consumers, when you are using out of network providers you may get stuck in the middle.
Many insurers use the Ingenix pricing guide to determine “customary” fees. The Ingenix guide is ultimately owned by United. It seems to work well for the insurers; maybe not for providers and consumers. Thus the lawsuits.
AMA sues UnitedHealth – Settlement $350M - The AMA and others claimed that UnitedHealth underpaid physicians and shortchanged consumers when paying out of network claims.
AMA is now suing both Cigna and Aetna on similar claims.
New York AG Andrew Cuomo settles with UnitedHealth- Settlement $50M – This settlement will be used to build a public database to track provider fees and ultimately United will discontinue the Ingenix pricing products in this area.
New York AG Andrew Cuomo settles with Aetna- Settlement $20M- Aetna settlement contributes to the development of the public database and will stop using the Ingenix pricing databases.
Reports state that Cuomo has subpoenaed Cigna, WellPoint and others. No settlements or resolution yet on those.
We’ll keep a watch out for additional settlements, the development of the public database and how this may help consumers.
update 2/18/09: New York AG Andrew Cuomo settles with Wellpoint - Settlment $10M - Wellpoint now joins other larger insurers by paying $10M to the yet to be created nonprofit database company.
WellPoint’s subsidiary Empire BlueCross Blue Shield (“Empire”) is the largest health insurer in New York State, with approximately five million members.
The Nonprofit database company has yet to be selected or announced. We'll stay tuned.
Many insurers use the Ingenix pricing guide to determine “customary” fees. The Ingenix guide is ultimately owned by United. It seems to work well for the insurers; maybe not for providers and consumers. Thus the lawsuits.
AMA sues UnitedHealth – Settlement $350M - The AMA and others claimed that UnitedHealth underpaid physicians and shortchanged consumers when paying out of network claims.
AMA is now suing both Cigna and Aetna on similar claims.
New York AG Andrew Cuomo settles with UnitedHealth- Settlement $50M – This settlement will be used to build a public database to track provider fees and ultimately United will discontinue the Ingenix pricing products in this area.
New York AG Andrew Cuomo settles with Aetna- Settlement $20M- Aetna settlement contributes to the development of the public database and will stop using the Ingenix pricing databases.
Reports state that Cuomo has subpoenaed Cigna, WellPoint and others. No settlements or resolution yet on those.
We’ll keep a watch out for additional settlements, the development of the public database and how this may help consumers.
update 2/18/09: New York AG Andrew Cuomo settles with Wellpoint - Settlment $10M - Wellpoint now joins other larger insurers by paying $10M to the yet to be created nonprofit database company.
WellPoint’s subsidiary Empire BlueCross Blue Shield (“Empire”) is the largest health insurer in New York State, with approximately five million members.
The Nonprofit database company has yet to be selected or announced. We'll stay tuned.
Wednesday, February 4, 2009
Physician Medicare Data Will Not Be Transparent
An appeals court just rejected a request to allow disclosure of Medicare data related to physician services. This is not a helpful ruling for those interested in increasing transparency of quality and costs in healthcare.
The Doctors: The American Medical Association representing the doctors asserts that doctors have a right to privacy so the data should remain private. And by the way, the information isn't perfect, so we wouldn't want to confuse consumers with information they probably can't understand.
The Government: The government has made many statements and taken actions to increase transparency (the new administration as upped the volume on 'open government'), yet Health and Human Services - HHS- stood in opposition to disclosure of this information. This is in contrast to their use of Medicare data disclosures for hospitals which they provide here.
The Judges: The lower court had ruled for disclosure of the information. The new court ruled that freedom-of-information laws are mainly intended to shed light on government operations, not the workings of private businesses. The government spends billions of dollars on healthcare services representing one of the larger and faster growing portions of the overall budget. It is hard to miss the connection to the government's operations.
Next Steps: The nonprofit Consumers' Checkbook group who brought the case is considering an appeal.
When a person contracts with the government, they might expect the terms of those dealings to be made open to the public. If a physician accepts payment from the public, does the public have a right to know about those payments? And do we really think information must be perfect before we disclose it? Do we want our government deciding which information we should get?
Unfortunately, the ruling goes against the trends towards increased transparency in healthcare. Let's hope the issue doesn't end here.
The Doctors: The American Medical Association representing the doctors asserts that doctors have a right to privacy so the data should remain private. And by the way, the information isn't perfect, so we wouldn't want to confuse consumers with information they probably can't understand.
The Government: The government has made many statements and taken actions to increase transparency (the new administration as upped the volume on 'open government'), yet Health and Human Services - HHS- stood in opposition to disclosure of this information. This is in contrast to their use of Medicare data disclosures for hospitals which they provide here.
The Judges: The lower court had ruled for disclosure of the information. The new court ruled that freedom-of-information laws are mainly intended to shed light on government operations, not the workings of private businesses. The government spends billions of dollars on healthcare services representing one of the larger and faster growing portions of the overall budget. It is hard to miss the connection to the government's operations.
Next Steps: The nonprofit Consumers' Checkbook group who brought the case is considering an appeal.
When a person contracts with the government, they might expect the terms of those dealings to be made open to the public. If a physician accepts payment from the public, does the public have a right to know about those payments? And do we really think information must be perfect before we disclose it? Do we want our government deciding which information we should get?
Unfortunately, the ruling goes against the trends towards increased transparency in healthcare. Let's hope the issue doesn't end here.
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