Blue Cross Blue Shield of Massachusetts thinks it may have a positive way to improve healthcare consumerism.
The payer is launching the SmartShopper Program for its self-funded employer plans on Jan. 1.
The program will reward members $250 per procedure when they “shop for and get care from lower cost, quality providers for eligible procedures like MRIs, mammograms and colonoscopies.”
Blue Cross Blue Shield of Massachusetts is calling the program the first that’s fully integrated with a health plan’s provider search tool. Members will use the payer’s Find a Doctor & Estimate Costs tool to see out-of-pocket costs for a procedure, as well as quality ratings.
Blue Cross is partnering with Vitals, which offers cost and quality transparency, for the SmartShopper program. The program recently launched a pilot with six cities and towns from the Massachusetts Interlocal Insurance Association (MIAA). More than 200 members have used the tool so far, but Chris Bailey, MIAA Health Trust manager, expects that number will grow once word spreads about the tool and cash rewards.
Joel Coffin, Blue Cross’ director of consumer transparency solutions, said the SmartShopper is a “natural evolution” to help members shop for care. To earn cash rewards, members need to log into their Blue Cross account, access SmartShopper through the Find a Doctor & Estimate Costs tool and search for an eligible procedure or call a “personal assistant” associated with the program. Then, they need to receive a service included in the program from a reward-eligible provider as the final step in receiving $250.
Other consumerism products in the industry include tiered plans that charge more for providers or services not deemed high quality. There are also narrow networks that completely remove some providers as an option based on cost and quality. These types of plans are not widely used in employer-based plans yet, but they're a popular payer option in the Medicare Advantage and Affordable Care Act (ACA) exchanges.
Earlier healthcare consumerism projects haven’t worked as well as hoped despite high-deductible health plans putting more costs on members. That was evident in a recent Health Affairs study, which found only 13% of respondents said they researched out-of-pocket costs before getting care. Only 3% of those surveyed said they compared healthcare costs by provider before receiving care. Plus, just one-quarter of them used a health plan, employer or public website.
Much like other types of consumer shopping, people can save on their healthcare by shopping. However, the question is: Why do so few people shop for their healthcare? Part of it is that we’re all used to listening to our doctors and following their orders. Another part of if is that for generations healthcare wasn’t thought of as the same as other consumer endeavors. And a third piece is that the information isn’t always readily available or made in an easily digestible fashion.
With the SmartShopper program, Blue Cross hopes to spark consumerism in its members and have them see healthcare similarly to shopping for a car. The SmartShopper may inspire members to try the tool, earn a reward and, in turn, help lower healthcare costs.