In the United States, the way that healthcare is consumed is changing rapidly. Just last month, people were able, for the first time, to sign up for healthcare coverage under the Affordable Care Act, a federal law that mandates health insurance for all Americans. Therefore, TheBurg, along with healthcare solution provider INGROUP Associates, asked several industry experts about those changes and how they impact consumers.
1. Today more cost transparency tools are available to consumers. These tools make the difference in cost for procedures between facilities more well known to consumers. The same procedure can cost 35-40% more between facilities. What are you doing to address these cost differences?
Highmark: Highmark Blue Shield provides easy-to-use quality and cost comparisons, along with other practical information, through a number of online transparency tools. By making cost and quality information transparent, we help members across all plan types make educated choices when deciding on physicians, hospitals, medical procedures and prescription medications.
Our transparency tools are simple to navigate and provide clear, up-to-date procedure cost and provider information. One of these tools is the care cost estimator which shows members what portion of a procedure they’ll be responsible for paying. This tool integrates provider allowances, deductibles, coinsurance and out-of-pocket information to calculate member cost-sharing on hundreds of inpatient and outpatient procedures. Estimates include the typical fee for a procedure plus the costs of related services, including facility, physician, lab tests, x-rays and more.
Capital Blue Cross: Capital BlueCross has been at the forefront of the industry in making costs transparent to our customers. They can sign on to our site at capbluecross.com and access the MyCareAdvisor tool to compare costs of health services at different facilities and make informed decisions about the care they choose and how much it will cost. We also provide consumers tools to make it easy to find providers in their area and with the specialties they need. Taking control of your health care doesn’t have to take a lot of your time.
UPMC Health Plan: Transparency will reveal variances in costs for the same procedures in different facilities. Many factors go into determining costs. While we cannot comment upon factors used by other providers, we can say that we do whatever possible to keep costs as affordable as possible. Additionally, we are committed to providing transparency not only on price, but also on quality. Every consumer must weigh all the factors that are important to them before they make their healthcare decisions. It is our intent to provide the tools and information to allow our members to make decisions that are right for them.
PinnacleHealth: PinnacleHealth has always been concerned with providing the highest quality care while helping to contain healthcare costs. By working closely with area employers and key stakeholders, we can continue that trend, as well as encourage patients to receive the right care in the right setting with an emphasis on preventive care and better coordination of care — all with a singular focus on the patient.
True cost is not published rates or charges–it is the negotiated payment rates between the insurers and the providers. Medicare also pays different amounts based on regional wage differences and the cost of medical education in certain hospitals. The real difference is what the insurance companies have negotiated and what the hospital and or physician charge an uninsured individual, and that information is not very transparent yet.
PinnacleHealth launched a new web-based tool called the PinnacleHealth E$timator to help prospective patients and their families better understand the cost of their healthcare. Found on the PinnacleHealth homepage, prospective patients can complete a three-part form to obtain price information about a diagnosis or procedure.
Employers are asking their employees to share more of the cost of their healthcare through high deductible health plans. PinnacleHealth is providing them with a tool to make more cost-effective healthcare choices. The Estimator can be used in conjunction with information provided by health plans and physicians.
The software application uses “average reimbursements” (not charges or ranges of charges), generating dynamic results. Hospitals might have very similar charges/rates for a given service, but depending on insurance contracts the difference in what the hospitals are paid and what is billed back to patients can vary significantly.
2. What are your perceptions of how the Affordable Care Act (ACA) will impact your industry and your company directly?
Highmark: We have been preparing our products, our systems and our communications for reform since the law was signed in 2010. We are offering a variety of health plans to meet the diverse needs of individuals and families through the marketplaces. In Central Pa., we are offering 13 plans for sale on the marketplace, as well as two Blue Cross Blue Shield Association multi-state plans.
We’ve worked hard to price these plans affordably, given the many new requirements and fees under reform. We and the industry have made it clear that costs for some people may be lower, and for others, it may be higher than previously, as a result of the law. We encourage people to learn more about reform by visiting www.discoverhighmark.com, where they can explore how reform works, what it means to them personally and what their coverage obligations and options are.
Capital Blue Cross: It is difficult to overstate what a change the ACA represents to the entire health care industry, let alone health insurance. While many employer-sponsored health insurance plans will keep their main features, insurers must adapt how they write insurance for individuals and small groups, how they manage risk across their consumers, and what kinds of services they cover. As a community insurer for 75 years, Capital BlueCross has always offered a variety of plans to meet the needs of our businesses and customers, and will continue to do so in the new health care environment.
UPMC Health Plan: There are approximately 200,000 uninsured individuals in our service area who will be able to purchase coverage on the marketplace. The Congressional Budget Office estimates that 20-30 percent of uninsured will purchase coverage in 2014. This equates to 40,000-60,000 new members on the marketplace, and the competition to insure those members will certainly have an impact on our company.
Overall, we expect one of the biggest impacts of the ACA will be that it will give an increasing number of consumers access to affordable coverage. Additionally, it should also allow for increased competition and transparency in the market, which should greatly benefit consumers in the end.
PinnacleHealth: The ACA is already driving change in the healthcare industry through various penalties and incentives connected to Medicare payments. Healthcare providers are brought into the driving force behind the ACA to improve the health status of America’s population and to reduce unnecessary costs through more coordinated care.
In addition, health systems are preparing and investing in additional providers, staff, HIT solutions and redesigning our care delivery model to implement community based care coordination.
3. What would you recommend to employers to help them control their healthcare costs? Has anything really changed for most employers under the Affordable Care Act (ACA) as they attempt to control future costs of providing their employees healthcare?
Highmark: The Accountable Care Act will ultimately mean more people get health insurance coverage and that is a good thing. It probably does not go far enough when it comes to addressing the costs of care and we know that costs now are unsustainable.
We work closely with our customers to meet their specific needs and develop a customized strategy. Employers need to look at their health plan design for example, how much cost sharing for employees do they want to consider. Employers also need to encourage their employees to get engaged in wellness and other programs through financial incentives so employees take greater control and responsibility of their own health care issues and have a greater role in how their health care dollars are spent.
Capital Blue Cross: Most large employers already offered their employees health insurance coverage before the ACA, and will continue to do so now that it has been implemented. The law means there will be some changes in the type and cost of coverage they can provide their employees, but it also means that small employers and individuals will have greater access to coverage, as well. In the long run, the fact that everyone must have health coverage will also make for a healthier workforce overall. While some of the mechanisms that have helped employers to manage health care costs have been significantly limited or even eliminated, such as preexisting conditions and waiting periods for coverage, there are still fundamental things employers can do to reduce the cost of coverage and increase the health of their employees. Implementing a health and wellness program is one example.
UPMC Health Plan: Population health management, with a focus on wellness and prevention, is a key element for employers to control healthcare costs. More than 50 percent of healthcare spending is on preventable illnesses due to unhealthy lifestyle habits. With the growing obesity crisis and the associated diseases that come with it (such as diabetes and hypertension), a comprehensive health and wellness program coupled with incentives can have a major impact on employer healthcare costs.
UPMC’s HealthyU products provide this type of program for employers by allowing employees who complete certain preventive and healthy activities to earn funds into a Health Incentive Account.
PinnacleHealth: We would recommend wellness and prevention programs and incentives, health risk assessments, and defined contribution plans. PinnacleHealth has a corporate wellness program, CARES, that provides an array of corporate and community wellness programs that include disease risk assessment, nutrition and weight advice, seminars from leading health experts, health fairs and disease prevention education. These are provided onsite at the workplace.
Employers now can choose whether and how they want to participate in providing health insurance to their employees. This is a game changer and will result in employer sponsored benefit reductions over time. New taxes, penalties and regulations have redefined the traditional role and given employers an out.
