Dive Brief:
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Harvard Pilgrim Health Care is working with MyHealthMath to help members choose the best health plan, including cost information.
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The payer launched the program to inform members of up-front costs before and after they select a health plan. The healthcare consumerism product includes “estimate my cost” and “reduce my cost” options.
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Michael Carson, president of Wellesley, Massachusetts-based Harvard Pilgrim, said in a statement that members have told the insurance company that selecting a health plan is challenging.
Dive Insight:
Payers are taking multiple avenues to boost member consumerism. At the same time, out-of-pocket costs remain a growing concern for patients and high-deductible plans and other types of benefit design are pushing more costs onto patients.
The partnership will provide consumer information for the nonprofit health insurer’s 3.2 million members in New England. Harvard Pilgrim offered MyHealthMath to employees in 2017 and expanded it to members after a positive response, the company said.
Carson said MyHealthMath uses “reliable data and statistics to close the gap for consumers and make the process as smooth as possible.”
MyHealthMath includes a one-on-one phone call with members. The program performs tens of thousands of calculations involving the claims process to figure out which plan would work best for that person’s needs. It then emails a report to show which plan offers the greatest value, and also includes a worst-case scenario.
CMS is also nudging hospitals to post prices. The idea is that more readily available price information will get patients to shop around for care and bring down costs. In a proposed rule, CMS would require hospitals to publish standard charges online and update that information at least once per year.
At the state level, Maryland recently launched Wear the Cost, a program that helps consumers compare prices for common non-emergency procedures at hospitals. Wear the Cost includes price and quality data based on commercial insurer data from 2015 and 2016.
Despite those kinds of efforts, a recent JAMA Network report said hospitals aren’t getting any better at providing price estimates. In fact, the study authors actually found price transparency is getting worse. The percentage of hospitals that weren't able to give any price information increased from 14% to 44% between 2012 and 2016.
A recent Kaufman Hall survey of 200 hospital and healthcare executives found that 90% of respondents said improving customer experience is a high priority. However, only 5% of organizations are aggressively implementing pricing strategies and price transparency.
Then there’s the issue of whether consumers would even use the information if they could get it. Studies show that Americans don’t price shop for healthcare despite higher out-of-pocket costs. The whole “skin in the game” argument in favor of shifting costs onto consumers has yet to clearly change outcomes or costs.