"Outcomes Update"

Payers Want Patients to Shop Prices at Doctors’ Offices

Health insurers plan to use cell phone feeds to provide prescription drug prices to patients

PRICE SHOPPING BY PATIENTS is getting major encouragement from the nation’s largest health insurance companies. But the big surprise is the proactive steps some insurers are taking to involve patients in decisions about their healthcare.

Take, for instance, a service that will let patients enter the name of a drug into the Web browser of their cell phone. They will immediately see a list of comparable drugs, ranked by cost according to the patient’s insurance plan! The goal is to let the patient, while still in the presence of the physician, ask about cheaper alternative drugs.

The company offering this service is Lumenos, Inc., based in Alexandria, Virginia. The company is owned by Wellpoint Systems, Inc., the largest health insurance corporation in the United States.

Suggesting Care Options

Another new approach to educate consumers is to send them letters that suggest questions to ask their doctors, tests and medications that might be appropriate, or alternative approaches to care that they can discuss with their physicians. Alternatively, some health plans are using financial statements to offer suggestions about care.

To take advantage of this demand for patient education, entrepreneurs have founded a company that contracts with health insurers to send these types of letters to their beneficiaries.

Based in Chevy Chase, Maryland, Resolution Health Inc. uses a proprietary system to analyze health plan data. It can then classify beneficiaries into clinically meaningful categories and identify opportunities to “improve the quality, safety and effectiveness of care being provided to each member.”

On behalf of its client health plans, Resolution Health can then send personal health statements to individual members—and an accompanying report directly to the member’s physician—that describes possibilities for improving the patient’s health. These statements also suggest ways the patient could reduce his or her out-of-pocket expenses. Major health insurers, including Blue Shield of
California, Horizon Blue Cross Blue Shield of New Jersey, and PacifiCare, use these services.

Making provider prices available to members is another strategy. Aetna, Inc. was first to do this when, for its members in Cincinnati, it began posting the prices it pays physicians on its Web site. Now Cigna Corporation has a similar program. It is going further, not only telling the member what the price is, but also what services should be provided and how many minutes he or she should typically spend with the doctor.

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