A recent article in the March issue of Consumer Reports identifies some contributing factors to the high cost of health care.  The article High Health Care Costs discusses some of the factors including:

 

1. Hospitals and doctors  - in our current health care system financial incentives are given for costly interventions rather than preventative care

 

2. Drug companies -  rise in prescription drug spending and large amounts of money being spent on pharmaceutical advertising (have you seen all the commercials?)

 

3. Insurance companies - increase in administrative and marketing costs contribute to inflated premiums

 

4. Politicians and government regulators - policies affect the bottom line

 

5. Lawyers- malpractice insurance premiums and defensive medicine (overuse of diagnostic tests)

 

6. Health care consumers - modifiable behaviors such as poor eating habits, lack of exercise, and smoking, all contribute to poor health

 

Here’s my recommendation.  Some of these factors consumers have no control over, but two of these factors consumers are definitely in the drivers seat.  First, healthy lifestyles result in healthy people. Make good choices.  Good health is priceless.  Second, consumers need to educate themselves.  Do your research to help you make informed choices about health care services.  Use tools like OutofPocket.com to look up prices, find the best value and make the most out of your health care dollars.  If you shop for health care services the way you shop for electronics, automobiles, and clothing, you will save yourself thousands of dollars.

 

Be sure to read the article When Consumers Are Driving Health Care, in the March 6, 2008 edition of the Raleigh News & Observer written by Max Borders, a Policy Analyst at the Civitas Institute. 

 

The seven million consumers with high-deductible health plans and HSAs, will definitely be able to relate to this story.

 

 

This free prescription discount card is available to residents in 47 states in a joint effort of your local county government and the National Association of Counties (NACo).  The discount card can be used at a participating retail pharmacy and can save you an average of 20% on your prescription medicine.  Nine out of ten pharmacies nationwide accept this card.   The discount card may be used any time your prescription is not covered by insurance.  There are no restrictions and no limits on how many times you can use this card. 

When I looked into this program for Cook County, Illinois, I discovered that many different counties across 47 states (excluding Connecticut, Rhode Island and Vermont) participate in this prescription discount program.  Be sure to checkout the NACo website to find out if your state/county participates in this free program.  This program targets the uninsured, and insured consumers where prescriptions are not covered by their insurance plan.

In January, the Consumer Health Care Blog posted ten useful tips to help consumers reduce their medical bills.  If you haven't read this article that was originally published on BankRate.com, be sure to check it out.

1. Ask your doctor to be your ally
2. Compare costs by using CPT codes
3. Find friends in the billing department
4. Negotiate lower prices, payment arrangements
5. Ask if recommended services are necessary
6. Explore state-sponsored hospital web sites
7. Check your insurance company’s website
8. Ask for the Medicare rates
9. Go generic
10. Sweat the small stuff

On January 24, Vanessa Fuhrmans wrote a story in the Wall Street Journal about insurers paying doctors to prescribe generic drugs, rather than name-brand drugs for their patients.   According to the story, Doctors Paid to Prescribe Generic Pills, the basic idea is to reduce health care costs for patients, employers and insurers by implementing an incentive program set up by health insurers to reward physicians for prescribing generic drug prescriptions instead of the more expensive, brand-name drugs.

 

I think this approach to reducing health care costs is wrong.  Consumers --not the providers are the ones that should be recipients of incentives by asking for generic rather than brand-name drugs.  If consumers can directly benefit by becoming cost-conscious, consumers will be motivated to ask for discounts, request generic prescriptions, and shop around for the best value in order to save money.  In fact, this type of behavior already exists with consumers that have high-deductible health plans.  Do you think a consumer that is responsible for paying $2000-$5000 out-of-pocket would choose to pay $230 for a brand-name prescription when he can save $170 and pay only $60 for a generic drug?  This already happens today just by asking your pharmacist or physician for a generic equivalent when filling a prescription.  Consumers are not rewarded by insurance plans for this cost-conscious behavior, but they do save money by shopping around for good deals.   Insurers and health care industry experts underestimate the intelligence and responsibility of consumers.  In every other industry, consumers are self-motivated to shop for the best value.  The same motivation would occur in health care if consumers were paying out-of-pocket for these services.  I’d like to see health plans reward consumers for making cost-effective choices by offering premium discounts to reward this good behavior.  Automobile insurance policies reward consumers with discounts for good driving records, anti-theft features on your car, vehicle safety, accident free, and new student drivers with good grades in high school. 

 

Mona

 

If you are one of the many consumers out there shopping around for an MRI because you have a high deductible plan and you are trying to manage your out-of-pocket costs --you are not alone.  How much will an MRI cost you?   Interestingly, prices for MRIs can range from $600 - $3500.  See for yourself, use OutofPocket.com to find out what other consumers have paid for an MRI.  Why the huge price difference for the same test?  Isn’t an MRI an MRI?  What’s the difference between a $600 MRI and a $3500 MRI besides $2900?  Personally, I’d much rather save the $2900 for summer vacation and find a trusted provider that offers me the best quality at the lowest price for the MRI.

 

If you live in the Milwaukee, Wisconsin area and need an MRI, you need to know about SmartChoiceMRI.com.  This independent outpatient MRI facility charges $600 for all MRIs, for every insurance plan.  They negotiated this rate with the 50+ insurance plans they accept.  How did they do this when all the other providers have “secret” negotiated pricing with insurance plans that can include sometimes up to 100 different prices for the same provider for the exact same service – but for different insurance plans?   I’d like to see more pricing models like www.smartchoice.com in the future.  It makes it so much easier for the consumer to compare costs, easier to budget, and makes the consumer feel like they are not being overcharged for the MRI.   

 

Results of this pricing model: 

• encourages competition
• creates more consumer-choices
• drives down prices, improves services
• encourages innovation
• increases patient care and improves the quality of care

This is a model we would like the health care industry to strive for!

 

Mona

This year there has been a lot of advice written by consumers, financial analysts, health industry experts, bloggers and even physicians, on how to lower your medical bills.  All the advice suggests that consumers should try to negotiate prices with providers for discounts.   Yesterday I worked up the courage to try out my negotiating skills with a pediatric specialist.  First of all, it was surprisingly easy and I definitely got the impression the office manager was asked this question enough that she had a prepared response.  

 

A survey conducted by the Consumer Reports National Research Center found only 31 percent of Americans have tried to negotiate the price of medical bills.  Of those consumers who tried, 93 percent have been successful at least once and more than a third saved over $100.  If you are insured with a high-deductible, uninsured, or under-insured, or looking out-of-network for services, you should ask the provider for a discount.   A physician I talked to from Mount Sinai Hospital suggested patients should offer to pay the provider the amount that Medicare reimburses and start negotiating from that amount.

 

I have a high-deductible health plan with Blue Cross Blue Shield.  This year my family was blessed once again with good health and we never got close to meeting our deductible.   During the last week of December, I scheduled an appointment with a pediatric specialist for a non-urgent consultation with my daughter.  This specialist came highly recommended and is out-of-network, and charges high rates for consultations -- a perfect opportunity for me to ask for a discount.  Before we saw the physician, I talked to the office manager and offered to pay cash for services even though I had health insurance.  The regular fee for a consultation is over $100 and they offered to charge only $50 for the office visit if I paid cash.  This is a great deal!  Benefits to the provider: they would not be submitting a claim to my insurance company for this service, they would not have to send me a bill for the office visit and they receive payment upfront.  Benefits to the consumers:  I saved more than 50% by writing a check at the time of visit.  Not a bad deal and for your new years resolution I recommend you try this out in 2008.

 

Happy New Year!

 

 

Are you paying too much for your health insurance?  Before you go out and replace your current health insurance plan, you really need to do your research to understand the different options that are available for you to choose from.  

                                       

Years ago, health insurance was almost always provided by your employer.  The only choice you had to make through your Human Resources Manager was whether to choose plan A, B, or C.  Today, more individuals are now purchasing health insurance on their own.  As the cost of health care continues to rise, many employers can no longer afford to provide their employees with health insurance.  Some businesses are even offering their employees more affordable options that are described with words like “consumer directed”, “high deductible”, and “HSAs”.  What exactly does all this mean to you?  If you have always had traditional first-dollar coverage employer-based health insurance, this could all be very confusing to you.  My advice to you -- before you go out and purchase health insurance on your own, you should get up to speed on some important issues that can save you thousands of dollars and avoid making painful mistakes selecting the wrong plan for you/your family.   Purchasing health insurance requires a level of knowledge that many of us are not comfortable with.  

 

I just read a book that does an excellent job informing consumers on how to save money on your health insurance.  This easy to read book, Get a Good Deal on Your Health Insurance without Getting Ripped Off, written by Jonathan Pletzke was recently published and is a must read if you are a consumer in the market for health insurance.   I highly recommend this book if you feel like you’re paying too much for your health insurance and want to understand your options.  For $16.45 at Amazon.com your return on investment (ROI) is substantial.  You can save yourself hundreds of dollars a month by becoming a well informed consumer and can avoid making the costly mistakes from purchasing the wrong type of health insurance plan for your family.   The book and accompanying website is available at www.BestHealthInsuranceBook.com. 

 

Happy Holidays,

Mona

 

 

Last week I attended the AHIP Business Forum that was held in Chicago on November 12-14.  The conference had outstanding speakers, and some very interesting ideas were being discussed concerning transparency. 

 

Pete Neupert, Corporate Vice President Health Solutions Group, Microsoft Corp. shared some practical comments about transparency during his keynote speech.  He described transparency as enhanced customer service.  He also suggested the healthcare industry should start using copies of data since the data is already being collected and the technology already exists.  Peter said data should be shared in a meaningful way.

 

Some of the challenges and chief concerns for transparency include:

 

·         Who will be the first mover to disclose this “secret” data

·         Who is accountable

·         Existing cultures within insurance companies are a huge barrier– guts to let go and share data

·         Existing complicated pricing structures (result of the system)

·         Are the motivations in the industry aligned

·         What is our capacity for change

·         Who will develop the standards

·         How will health plans use the information to make it available to members

 

One of the presentations at this conference was an interactive session, “Preparing for Transparency: What it Means to You” and included lively discussions on transparency.  The discussions included understanding the vision behind a transparent health care system, how transparency promotes competition in a consumer-driven world and practical approaches and tools for achieving transparency.

 

The session was presented by:

Mark Ganz, President and CEO, The Regence Group

Luis Machuca, President and CEO, Kryptiq Corporation

 

Guiding Principles for Transparency

1.       Focus on the consumer

2.       Cover members, providers and organizations

3.       Requires historic collaboration across the industry.  Understand the difference between competitive differentiation and common infrastructure

4.       Must be forward focused and relevant and valuable to the consumer

5.       Requires significant culture shift  (control à empowerment)

   

The closing keynote speaker was Regina Herzlinger, professor of business administration at Harvard Business School, senior fellow at the Manhattan Institute and author of “Who Killed Health Care?” Regina is a powerful speaker.  She fills the room with compelling research statistics, bold statements, and her humor.  Regina is an advocate of market-driven, consumer-oriented health reform.  Her powerful closing statement was, “….the governments micromanagement of the prices of insurers and providers should be avoided, not emulated.  Instead the government should help lower-income people, enforce transparency, prosecute fraud and abuse---but otherwise get out of the way.”  I had the honor of meeting her in person after the event and I mentioned OutofPocket.com to her.  She said my price transparency tool using consumer collaboration to expose true prices is a great idea!

Instead of sitting  back and waiting for the government, providers and insurers to publish meaningful price data to help consumers make informed decisions about value, we developed a solution that can help consumers today.  In July, we launched an early release of www.OutofPocket.com, a platform for collecting and sharing price information for routine health care services.  This online resource, OutofPocket.com, enables consumers to share price information that can help others find the best value.  Our objective was to collect early feedback, build awareness for the new website, and enable people to start sharing price information to help others find the best value.  While the website is still evolving, we strongly believe that launching OutofPocket is better than doing nothing.   OutofPocket is available today for consumers to start collecting and sharing true prices for health care services.

 

To everyone that sent us comments - thank you for taking the time to review our website and send us your feedback.  We consider your feedback a gift. 

 

Over the next couple of months we will be working on the next release of the website.  Our #1 goal is when you search on OutofPocket.com, you will always have relevant content returned in the search results.

 

Some of the features we are working on include

1. enhance the wizard to make it easier for you to post you visits/prices/recommendations

2. allow users to rate search results and add their recommendations to a provider already in the directory

3. invite providers that disclose pricing to include their services/prices in the directory

4. include additional Government CMS Medicare payment data

5. improve the dislay of search results to identify consumer-generated-content, provider price list, and Medicare data.

     

We invite you to continue adding your visits and price information to the directory.  If enough people participate to share prices, consumers will have created a very powerful pricing directory.  Thank you for all that you do to help make this grassroots initiative successful. 

This past summer when my kids went to the Pediatrician for their routine checkups I saved hundreds of dollars -- $475 to be exact!  When the doctor mentioned that my kids were due for vaccinations I said “no thanks”.  Instead, I asked the doctor to write down the scheduled vaccinations.  I informed the doctor that we were going to the Village to receive our vaccinations for $5 each.  The doctor was happy to accommodate my request.  In fact, I think the doctor’s office knew all about this cost savings program but never mentioned it me.  I never knew about this program until just recently, so I never asked.  

 

The Village of Arlington Heights, offers $5 vaccinations on the third Monday of every month to families that are uninsured or under-insured (where your health plan does not cover vaccinations).  The vaccinations are administered by professionals in a very clean environment and held at the recently remodeled Senior Center conveniently located near my home.  We only had to wait 5 minutes to fill out some forms.  Many other villages and the county offer these low-cost or free vaccinations for children and full-time students.  Definitely worth checking out if your health insurance does not cover vaccinations or if you are uninsured.     

As more costs are being passed on to the consumer, it has become even more important for consumers to understand and compare prices of health care services before receiving treatment.  Here is some advice that can save you real money.

 

Negotiate

 

Dr. Kathryn Stewart, Medical Director of Care Management at Mount Sinai Hospital in Chicago, believes patients should be more proactive about seeking the best prices for services.  In fact, Dr. Stewart suggests patients negotiate a payment arrangement with the provider before they have the service performed.  Dr. Stewart advises, “Patients can always negotiate the price before or after the service is received.  Don't just accept at face value to pay what the provider is charging.  Most hospitals would be glad to give a deep discount (up to 50% or more) if patients pay at the time of service. The discount is less if patients drag payments out over a long period.   Keep in mind that charges and payments have almost no relationship to each other and charges are a pie in the sky number that no one pays except for the self-pay patient, and that is only if they are not smart enough to negotiate a lower payment for themselves. Most important - after you have received the service you are not in a good negotiating position.  However, before you receive the service, you are in a better position to negotiate the price.”

 

Ask for the Medicare Rate

 

If you are uninsured, you really need to negotiate a better price.  Ask the provider what Medicare would reimburse them for this procedure.  Start with this price and see where you end up. 

 

Good luck.

"You can't drink that!" my wife reminded me as I mixed the fruit juice concentrate.  “You have the health screening tomorrow morning and you must fast for 12 hours."

My wife shops for healthcare and she found a great deal offered by the Village of Mount Prospect’s Human Services department and Resurrection Medical Center.  For $30, I receive blood tests including: complete lipid panel, complete metabolic panel and complete blood count.  For $20 more, I can receive a prostate screening.  The village also offers a free blood pressure test.

So this morning, feeling a little hungry and caffeine-deprived I arrived at the Village Hall for my screening.  After I paid with a personal check, I quickly walked through the stations which included blood pressure, blood draw, and even filling out a self-addressed envelope for my results.  I asked the lab technician how the prices could be so low when the same tests would cost $200-300 at a physician’s office.

“The hospital considers it a community service and breaks even by using it as a tax deduction,” she said.  “We do these screenings a couple times a month at village halls, churches, and senior centers.”

The last station was a table of bagels, donut holes, juice and coffee.  Say, this is a good deal.  My doctor never fed me breakfast!

-- posted by Pat Frisbie

I was a competitive runner for more than 25 years, and several years ago I started to experience a pain in my knee that just would not go away.  No matter how much ice, rest, and physical therapy – the pain was persistent.  I finally made an appointment to see a sports doctor.  After the doctor spent 10 minutes with me, he suggested I have an MRI on my knee – which is a very expensive test for someone that has to pay for the entire bill out of pocket.  I mentioned to the doctor that I had a high-deductible insurance plan and he gave me several diagnostic facilities to contact.  I called every single facility.  In fact, I even called my health plan provider.  I called diagnostic facilities in and near my neighborhood.  I learned that an MRI is an expensive test that can cost anywhere from $500 - $2500, depending on where I decide to go for the test.  And to make matters worse, not a single provider, or insurance carrier could tell me what my out of pocket cost would be for an MRI with my health current insurance plan.  I learned that my health insurance plan negotiated discounts with providers.  Some discounts were more substantial than others and this could make a big difference in MY PRICE.  Every health care provider and health insurance representative I talked to would not share this with information with me. This rude awakening was the beginning of a journey for me.  I realized first hand that consumers need easy access to meaningful tools to help them make informed decisions about where to find the “best value”.  To be honest, I was not shopping for a complicated surgical procedure; I was just looking to find the best price and quality for an MRI so I could find out why I am in so much pain when I run.  I did not want to be overcharged - I just wanted to pay a fair price.  Is that asking too much?

 

I think most consumers would be outraged if they knew the true cost of health care services.  There are so many different prices for the exact same service.  How are consumers expected to know the difference?  I learned about similar experiences from many other consumers that had similar stories of “the priceless MRI”, so I decided to do something about this problem.  Using the power of the internet, and taking advantage of social-networking, I decided to build a portal where consumers could share prices and personal recommendations on providers, with other consumers.  If enough consumers participate to share prices, consumers will end up creating a powerful tool to help make informed health care purchasing decisions.  Until the industry catches up, consumers are going to have to be creative and resourceful when researching providers and facilities to make the most out of their health care dollars.  I encourage you to check out the website, www.outofpocket.com.  Be sure to tell your family and friends about this project, and let me know what you think.  The best part about this initiative is that is benefits all consumers, including the insured and uninsured, without having to wait for legislation to pass, complicated programs to be initiated, or waiting for the country to decide how to reform our health care system.   

- Mona Lori

Several years ago I decided to switch to a high-deductible health insurance plan (HDHP) for myself and my family.  I pay 100% of my own health insurance premiums and one of the factors that influenced my decision to switch was how expensive my insurance premiums were getting even though I basically made no insurance claims over the past five years, other than annual check-ups.  After my accountant suggested I look into high-deductible plans, I calculated that I could save $7000 in premiums every year and use my HSA to help pay for my medical expenses.  With my HDHP I have become a cost-conscious consumer of health care services, and I shop around for the best value, just like I would shop around for a car or electronics.  The only problem is there are no Consumer Reports for health care where I can easily find the best value for health care services.  I have no meaningful tools to help me make informed choices about where to find the best value for routine health care services like MRIs, X-rays, vaccinations, mammograms, and office visits.  How do I avoid the overpriced providers with poor performance ratings?  Now that I pay out of pocket for these services (up to $5000), how do shop for value?  How do I find out what other patients think of a physician that is listed in my plans network?

 

-- posted by Moni Lori