Next year, CIGNA will be (financially) encouraging members to go to more cost efficient providers. The mid-tier health plan has announced that it will be charging members less if they go to lower cost physicians.
CIGNA’s not alone. Aetna’s been a leader in disclosing cost data. Other health plans, partially motivated by a mandate from the Federal Employee Health Benefit Program to publish cost data, more and more health plans are dipping their corporate toes in the water.
Unsurprisingly, provider groups are loudly protesting the incorporation of cost data in network evaluation, saying it should not be the “primary factor”.
Why not?
As long as there are some objective measures of quality, presented in a way that a reasonably intelligent person can understand, with the ability to talk with a member “ombudsman” about their questions, and a recognition in the benefit design that emergent situations don’t incur financial penalties, what’s the issue?
What does this mean for you?
More information will help patients vote with their wallets.
But we have a long way to go.
At a recent investor conference, Cigna cited an example of a roughly fivefold variance ($2,500 vs $500) in the cost of an MRI among providers in the same area. With either a high deductible health plan or even just a 20% co-pay, patients (and doctors) should have this information in hand before deciding which imaging center to go to for the procedure. If confidentiality agreements stand in the way of disclosing what insurers actually pay providers for services (as opposed to list prices), those agreements should be eliminated, by legislation if necessary.
And just what are those “objective measures of quality” Joe?
Nickel and diming health care in an attempt to reduce costs, doesn’t do anything to solve the real problems of US health care.
Whether one test costs $2500 at one center, and $500 at another is irrelevant. What is relevant is whether the test is needed at all.
What is relevant is how much is spent where the cost far exceeds the benefits received.
In health care, it’s not about competition. Where’s the cut off point, when cost considerations override trust and quality concerns.
How can anyone put a price tag on their health?
One must consider that in primary care practice and many specialized areas as well as region significant shortages of providers exist. The challenge will be how long it will take to be treated at all. In orthopaedics for example utilization of a functional outcome tool such as sf-36 requires additional time, lots of time. I agree that we should be looking at the easy metrics and offering benchmarking. In the end dollars that are needed for prevention and patient care will be diverted to administrate costs associated with measuring, marketing and paying insurance and managed care executives. Need to change completely our priorities and funding of health.
As Marc quite correctly said, what are the “objective measures of quality”?
The discussed quality measures include very specific measurable things like “did you prescribe statins for this level of LDL” or “what percentage of people do all recommended tests”. Aside from the fact that such measures discorage any kind of discussion of benefits and risks, these measures tell me more about doctor’s power of persuasion than about his or her competence.
These measures do not tell me if this doctor is good at diagnosis, if this doctor is up-to-date on his/her knowledge, how well this doctor can do the procedures he does, or if this doctor knows about drug interactions. You can say you measure outcomes, but one doctor may treat riskier patients and how will you measure this? Frankly, I am more interested with what my doctor does when I am sick then how well he harrasses me when I am healthy.
Your “objective measures of quality” will lead to even more doctors “convincing” patients to follow the guidelines by any means including sugar-coating the risks of recommended measures and framing the data about the benefits to make them appear larger (e.g. using meaningless RRR instead of ARR or NNT/NNS). Not only will this lead to higher cost since many of these recommended measures are not cost-saving given high NNT and in case of tests, high number of false positives, but they will lead to even more people overestimating the power of “prevention” and suing doctors if these measures fail and getting high awards in “this wasn’t detected early enough” lawsuits. This is already happening with mammograms.
I couldn’t tell if the 2nd half of your post was in jest or not. As long as all those things listed become reality, it will be great. How long until all those things you listed become reality?