By Christopher J. Gearon
Special to the Washington Post
Tuesday, October 24, 2006
Chances are you've already bought clothes over the Internet and gone comparison shopping online when investing in a new computer, and you'd probably check out Web sites to guide your choice of new car. But what about online shopping for knee replacement surgery? Or for the treatment of your child's chronic ear infections? Believe it or not, those are questions you should be asking yourself as you head into your company's open-enrollment bazaar this fall.
Here's why: These days, more of the cost for everything from surgery to prescription drugs and doctor's appointments is likely to come out of your own pocket. That's not just because health insurance premiums are continuing their steady rise, but because deductibles and other out-of-pocket costs are increasing rapidly, giving consumers a new incentive to shop smartly for health care.
It's all part of a cost-conscious trend known as consumer-driven health care, in which workers pay a higher proportion of the costs in the kinds of high-deductible plans that are steadily replacing managed-care offerings. And don't expect to find much relief in PPOs and other traditional insurance plans; they too require enrollees to shell out more for services.
When it comes to your health, it pays as never before to be informed.
The good news is that the health-care industry is gradually making the information you'll need to reach decisions available to you -- online. It's an imperfect process at this point. But this fall, millions of workers choosing their 2007 health insurance options will have new Web-based tools that can help them pick the plan tailored to their specific needs and find pricing and quality ratings on specific doctors, hospitals, medications and medical services.
Some of these Internet services even allow consumers to sniff out good deals on medical care: If you need a CT scan, for example, you can key in a Zip code and then receive expected costs at nearby facilities (prices ranged from $280 to more than $1,000 in one D.C. search); some services also highlight, based on your health plan, what proportion of that total you can expect to pay out-of-pocket.
A brief survey of what's available this fall reveals that the online options vary significantly in their ease of use, their accessibility and on what they deliver. What's more, unlike buying a car, a computer or a new piece of clothing, health-care choices are rarely driven by cost alone -- or even primarily by cost. "What it costs doesn't have a whole lot of meaning until you know something about the quality of that care," says Carolyn Clancy, director of the Agency for Healthcare Research and Quality and a key player in the federal government's drive to make health-care pricing and quality more transparent. "You need them both."
What is clear is that consumer-driven care -- or at least higher consumer costs -- is the way of the future, giving you and me a new incentive to learn how to use it.
Many people have grown accustomed to turning to the Internet for information on medical conditions, preventive care and nutrition through sites such as WebMD and PubMed. More recently, individuals have used online tools to search provider directories, check claims status or change doctors. Now they can turn to sites offered by Medicare, which provide information on both pricing and quality of care, as well as Aetna, Cigna, UnitedHealthcare and WellPoint. Entering the fray later this year is District-based Revolution Health, backed by America Online co-founder Steve Case and others, aiming to provide a "completely intuitive" consumer-friendly health portal.
These sites are evolving -- and improving -- quickly, but a number of challenges remain that were identified last year in a report card on several consumer-driven health plans that appeared in the peer-reviewed journal Health Affairs. The article gave largely poor grades -- D's and F's -- to the online information that plans made available. "Frankly, the information the consumer would want to determine value wasn't there," says Arnold Milstein, chief physician at Mercer Health & Benefits LLC and co-author of the article. A big problem with most tools, Milstein says, is that pricing information, for example, gives consumers no insight into a particular doctor's practice style -- whether the doctor tends to order several tests, for example -- or whether the treatment might ultimately involve other providers and procedures.
Another knock is that many of the sites are not user-friendly. "Consumers want this information, but they want it in a form where they can make decisions without doing a math equation," says Roger Feldman, a professor of health insurance and professor of economics at the University of Minnesota.
A third unmet need is to tailor costs to the patient. In most Web-based tools, "the cost displayed is not necessarily the cost to me; it's the average cost," noted Jay Silverstein, president of Revolution Health. Silverstein says existing tools rank a "one out of 10."
Some of the stronger online tools are addressing problems of this kind. Before going to the doctor, a member in one of WellPoint's high-deductible health plans can, for example, log on to the insurer's Web site and check physician's prices on a handful of services, comparing them with prices that other area doctors charge, see if any disciplinary actions have been taken against the doctor, read patient reviews on the provider, and later even contribute one.
That's just for starters. A WellPoint enrollee needing her gallbladder removed can compare the rates area hospitals charge for the procedure, while checking each hospital's performance for such complications as infection rates. The typical charge at Holy Cross Hospital in Silver Spring, for instance, runs between $4,600 and $8,900 for laparoscopic gallbladder surgery. The member also can find out how much of that cost she'll pay, based on her particular WellPoint plan.
Anyone who has banked or shopped online would have little trouble tracking out-of-pocket costs, comparing drug prices at pharmacies or finding the typical treatment and associated costs for, say, asthma or allergies.
"We think the real answer [to controlling health-care costs] is the informed consumer asking questions," says Doug Kronenberg, chief strategy officer of Lumenos, an Alexandria-based unit of WellPoint that provides information about consumer-directed plans.
A driving force behind this change is the federal government. Each year, federal programs such as Medicare and the Federal Employees Health Benefits Program spend 40 percent of all U.S. health-care dollars. President Bush in August issued an executive order directing all federal health-care programs to provide more and more-accessible information to their members. That, in turn, is quickening the pace of getting such information to all consumers and other health-care payers.
While he's aware of their shortcomings, Health and Human Services Secretary Mike Leavitt says the Internet tools currently available are "groundbreaking first attempts."
"The biggest strength is we're beginning to think about value," Leavitt says.
"It's taken a long time for people to understand your health is your greatest asset," says Joseph Donlan, a vice president for Chicago technology firm Subimo. It also has taken a long time for insurers and the health-care industry to make these tools available.
"Keep in mind, this is information that used to be stamped 'private' on internal documents," says Mark Lindsay, a UnitedHealthcare spokesman. "It's a complete transformation, and it's just the beginning."
The tools arrive in the nick of time. Health-care inflation continues to outpace pay raises. On average, American families this year are paying nearly $3,000 in health insurance premiums, 84 percent more than they did in 2000, according to a recent Kaiser Family Foundation and Health Research & Educational Trust report. Wages have risen just 20 percent in that time. Moreover, single coverage under a PPO plan carries a general deductible of $500 on average -- that's after premiums and before separate hospital or drug deductibles, co-insurance or co-payment obligations. And the typical enrollee in a high-deductible plan must pay a $1,715 deductible this year before insurance kicks in.
If the new tools are to work, though, they need to help consumers not only stretch health-care dollars but remain on top of quality. "If the hip replacement is really cheap but [the hospital's] complication rate is high, a lot of people wouldn't consider that to be a terribly good deal," Clancy says. "The goal is to give consumers user-friendly information on their cost and quality of care so they can make the best decisions for themselves." ·