Consumer Price Transparency Examples State and National Websites
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- Charlene Allison
- 5 years ago
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1 Consumer Price Transparency Examples State and National Websites State Consumer Health Information and Policy Advisory Council Meeting March 24, 2016
2 Health Transparency Websites What do consumers want to know: How much is that procedure? What is included in the costs? What are my out-of-pocket costs? Where can I get the best care for my money? What if I can t pay? Does my insurance cover this test or drug? Couple of Facts: 77% of Americans spend time online searching for health information Consumers more likely to use health information websites that are easier to navigate than those perceived as trustworthy - "willing to forego trust to have easier-to-access information,. 2
3 Fairhealthconsumer.org Estimate medical and dental service costs for insured and uninsured Data source is healthcare claims (charges for 18 billion medical and dental services), CMS claims (1 billion) and 151 insured plan participants Charges are an aggregation of non-discounted fee-for-service and data is based on 100% of payer s claims for a submission period Includes non-discounted charges for all in-and out-of-network claims Uses CPT codes and Dental (CDT) codes Consumer Cost Look-up provides estimated charges, out-of-pocket and reimbursement (may select Insured/Uninsured) Option to add anesthesia charges Percentile calculations adjust to show high/low charges Shows usual, customary and reasonable (UCR) rates; used by insurance carriers to set out of network reimbursement rates Site tracks computer IP address and allows only 15 searches per week 3
4 Fairhealthconsumer.org 4
5 Fairhealthconsumer.org 5
6 Guroo.com Provides amounts paid by insurers and patient out-ofpocket expenses Source of data is medical and pharmacy claims for 40 million people (from all states) Payers include: Aetna, Humana, United Healthcare, Assurant Shows average and range of costs for procedure/care bundle (national and state): Possible treatment program the provider may utilize Derived from claims information that combines inpatient, outpatient and ancillary claims to build an example of treatment episodes Uses ADAM virtual tool; similar to FloridaHealthFinder.gov Source: Health Care Cost Institute (HCCI) database 6
7 Guroo.com 7
8 Colorado Comedprice.com Colorado State APCD Source of data is 14 commercial payers, and Medicaid Payers include: Aetna, Assurant, Cigna, Humana, State Farm and United Health Care Presents median total amount paid by private insurance, Medicaid or No Insurance (copay, insurance, deductible) Price includes facility fee, professional payments made by insurance, and cost of actual procedure Presents total charged amounts for uninsured Currently covers data on cesarean and vaginal births, hip and knee replacement Prices are calculated using Treo/3M s All Patient Refined Diagnosis Related Group (APR-DRG) and ICD-9 codes Provides a cost calculator to help patients estimate their own potential out-of-pocket share; My Price tool allows patients to enter deductible, coinsurance % and select payer for a more accurate estimate 8
9 Colorado Comedprice.com 9
10 Colorado Comedprice.com 10
11 Colorado 11
12 Colorado 12
13 CompareMaine.org Aimed at insured individuals Source: 25 million claims from 49 health insurance plans; does not include public payers (MaineCare and Medicare). 13
14 Reports average cost based on the calculated median, represents the amount paid by the insurer and patients out-ofpocket costs. Information on over 200 healthcare procedures from more than 170 facilities; includes hospitals, physician practices, specialty care centers, labs, and radiological and imaging centers. Total cost may include provider costs paid to the doctor, nurse, or other healthcare practitioner, and facility costs. Accounts for insurance - average combined cost calculated using average median, figure includes payments from an insurance company, co-pays, co-insurance, or deductible payments from the patient. Episode includes the main procedure and related procedures or services occurring 30 days before and after the main procedure (includes tests, surgery, medical supplies, follow-up exams, physical therapy, and related medications). Uses Medical Episode Grouper (MEG) by Truven Analytics. CompareMaine.org 14
15 Maryland Medical Care Database 15
16 Maryland Medical Care Database 16
17 New Hampshire HealthCost Source: The New Hampshire Comprehensive Health Information System which presents claims data and Health Employer Data and Information Set (HEDIS) data mandatorily submitted by insurance carriers in the state. 17
18 New Hampshire HealthCost Consumers can compare estimated costs based on actual prices Website provides estimated total cost for facilities and professionals in New Hampshire for insured and uninsured. Shows medical, dental and services including MRIs, dental cleanings, and lab tests Allows consumers to select insurance type, deductible and co-insurance; Provides an estimate based on bundled services; Presents case/patient severity and the accuracy of the cost estimate. 18
19 New Hampshire HealthCost Cost estimates are based on median amounts paid by both the insurance carrier and the patient or, the "allowed rate" of payment to health care providers. When the patient is insured, the cost to the patient for covered services is based on a contract between the provider and the insurance company. Uninsured or non-covered services reflect costs based on charges minus any discount the provider offers uninsured patients. Cost are presented bundled and unbundled Bundled costs consist of nearly all of the individual charges associated with the procedure a button icon and statement to indicate that the cost of the procedure shown is an aggregate of the typical costs a patient will likely pay. Unbundled costs are presented with notations to indicate that the cost and the patient may experience more than one procedure at a time. Website also presents the average cost for the 20 most common lab tests at the 25 lab facilities that do the most lab tests represents 47% of all lab tests performed in the state. 19
20 Discussion 20
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No. What is not included in the out of pocket limit? Even though you pay these expenses, they don t count toward the out-of-pocket limit.
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Important Questions Answers Why this Matters: What is the overall deductible?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-405-682-4581. You may also visit www.dol.gov/ebsa/healthreform
Anthem Blue Cross Your Plan: Custom Anthem HSA /40 Embedded (HSA291) - Actives Your Network: Prudent Buyer PPO
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You can see the specialist you choose without permission from this plan.
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A, B, C, Ds of Medicare
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Northern Simple/Fácil Catastrophic: Nevada Health CO-OP Coverage Period: 01/01/ /31/2015
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.nevadahealthcoop.org or by calling 702-823-2667 or 1-855-606-2667.
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com or by calling 1-855-333-5735. Important Questions
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.crystalrunhp.com or by calling 1-844-638-6506. Important