En­cour­ag­ing pa­tients to shop around

Modern Healthcare - - Innovations - By Rachel Z. Arndt

Given health­care prices that don’t seem to budge, con­sumers hope to save money by shop­ping around. But even then, price trans­parency across the in­dus­try lags and real cost in­for­ma­tion is hard to come by.

Vi­tals CEO Hey­ward Doni­gan and her team want to change that with SmartShop­per, a tool that pro­vides pa­tients with prices from var­i­ous providers so they can choose who they see based on cost.

SmartShop­per en­cour­ages savvy shop­ping by let­ting em­ploy­ers or health plans cus­tom­ize a cash re­wards pro­gram for pa­tients who choose lower-cost providers.

Vi­tals’ clients in­clude some of the big­gest health plans in the coun­try— An­them and High­mark, to name two—as well as in­te­grated de­liv­ery net­works like Kaiser Per­ma­nente and self-in­sured em­ploy­ers. Only pa­tients whose health plans or em­ploy­ers have signed onto the tool can ac­cess it.

When they do, the sav­ings can be sub­stan­tial: On av­er­age, a pa­tient will save $606 for each pro­ce­dure they shop for us­ing SmartShop­per, with sav­ings rang­ing from $1,810 for a course of phys­i­cal ther­apy to $80 for a mam­mo­gram. Em­ploy­ers save too, cut­ting med­i­cal spend­ing by more than $56 mil­lion be­tween 2015 and 2018.

For self-in­sured em­ploy­ers, the ef­fects can be sub­stan­tial, said Steve Crist, head of large group em­ployer ac­counts for Blue Cross and Blue Shield of North Carolina. “Even just one per­son shop­ping can make a dif­fer­ence for that em­ployer in terms of the claims they’d be pay­ing out at the end,” he said. Even though the em­ployer is pay­ing the in­cen­tive, the cost sav­ings more than make up for it, he added, say­ing, “The ROI on this pro­gram is very strong.”

But not ev­ery­one is so lucky, since they might not work for an em­ployer that of­fers a tool like SmartShop­per, said Ja­cob Galante, di­rec­tor of strat­egy con­sult­ing at Op­tum. “The adop­tion rate isn’t that great,” he said, even for those to whom the ser­vice is offered. That could change in the new year. “We would ex­pect to see a re­ally big push on ed­u­ca­tion in Q1, since de­ductibles are re­set­ting,” he said.

In Au­gust 2018, Vi­tals sold off its con­sumer ser­vices di­vi­sion to We­bMD. Since then, it’s been able to fo­cus on its price trans­parency busi­ness. Over the next year, it will con­tinue that work, as well as com­ing up with a new brand and name.

The com­pany will also push its new­est of­fer­ing, Med­i­cal Ex­per­tise Guide, which pro­vides sur­gi­cal pa­tients with sup­port in ad­di­tion to what they get from SmartShop­per. Peo­ple can ei­ther get in touch with MEG staff on their own or they can wait un­til staff reach out to them after thor­ough pre­dic­tive mod­el­ing sug­gests they’ll need surgery in the fu­ture.

Take knee pain, for ex­am­ple. Nine- ty per­cent of peo­ple di­ag­nosed with os­teoarthri­tis in the knee get MRIs within two weeks of di­ag­no­sis, and 35% of peo­ple get a knee re­place­ment within five years. In that case, Vi­tals staff would reach out to talk to pa­tients about which care op­tions might be in their fu­ture.

This is an ex­am­ple of a “clin­i­cal path­way for shop­ping,” Doni­gan said. The com­pany can cre­ate those path­ways by draw­ing on the 7.6 mil­lion data records it pro­cesses ev­ery day.

Get­ting pa­tients to trust the in­for­ma­tion they get might still be tough, said Becca Lo­coco, vice pres­i­dent of con­sult­ing at Op­tum. “Be­cause there are so many tools avail­able, quot­ing dif­fer­ent costs and prices, con­sumers are con­fused as to what their ac­tual out-of-pocket will be,” she said. But when con­sumers do start trust­ing price trans­parency tools, the ef­fects will be sig­nif­i­cant. “Up to 7% of over­all health­care spend could be re­duced through price trans­parency tools like SmartShop­per,” she said. “This can cre­ate a re­ally healthy com­pet­i­tive en­vi­ron­ment in an in­dus­try where costs are al­ready ris­ing.”

The SmartShop­per tool of­fers pa­tients a menu of prices from a va­ri­ety of providers so they can go com­par­i­son-shop­ping.

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