Health Insurance: Open Enrollment 2006

When it comes to health care, it pays to be informed. So, read on for help in making sense of your options.

DIY: Online Tools Can Help Identify the Best Plan
Insurance Sites' Pros, Cons | Health Site Test Drive
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PRIVATE INSURERS

Sites for More Eyes

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Tuesday, October 24, 2006

Aetna

Aetna offers well-designed online resources for its members at http://www.aetna.com/index.htm . The tools let members tap into the prices that area providers charge for treating dozens of diseases and medical conditions, and for performing surgical procedures, diagnostic tests and more. This summer, Aetna added doctor-specific pricing data for 30 common services performed in Washington area doctors' offices.

When members seek that pricing information, the site overlays data about the quality of care provided by individual physicians, allocating a star to those who meet certain clearly defined standards.

Using Aetna's DocFind tool, a user can access details about many physicians, from their board certification status to service quality and cost information. A member also can research whether a particular symptom may warrant a doctor call or visit.

"We're trying to help members plan for health-care costs and their health," says William Fried, Aetna's medical director for the mid-Atlantic region. "An engaged health-care consumer is more likely to make better decisions."

Pro: Consumers can rate medical professionals and read others' ratings; that's sure to become a popular patient destination. The new pricing information for office services is based on what Aetna pays specific physicians, as opposed to the average rate in a geographic area -- a real plus.

Con: Aetna does have a prescription drug pricing tool, but it is offers less information on, for example, specific pharmacies than other insurers do. And while it's handy to be able to scope out the prices a specific physician charges, the user gains little information about what the total visit may cost, especially with test-happy doctors.

What's ahead: On Jan. 1, Aetna expects to launch an "informed care decision" tool, highlighting for members the treatments available to them according to their own medical record, their diagnosis and the severity of their condition. Based on a treatment's effectiveness, safety, side effects and other factors, Aetna will provide "treatment scores," in an effort to prompt the member to have a discussion with a physician.

CareFirst BlueCross BlueShield

CareFirst offers a robust site, My Care First, at http://carefirst.staywellsolutionsonline.com/ . Geared to helping members stay well and manage chronic conditions, the site offers less information on pricing and quality than some others do. The reason, said officials, is that CareFirst only recently launched its line of consumer-driven health plans; the company doesn't want to tick off physicians, either, it seems.

"We need to do it in conjunction with our partners, which are providers," says Amy Doherty, CareFirst's product manager for consumer-driven health plans.

CareFirst encourages its members to compare hospitals' performance on dozens of procedures by using an online tool. A query about coronary artery bypass graft (CABG) surgery, for example, showed that Inova Fairfax Hospital did 1,056 such procedures in a recent 12-month period. But Inova Alexandria Hospital, performing just 157 during that same year, had the lowest proportion of patients who died while being treated -- fewer than 1 percent. (The average CABG fatality rate at area hospitals is nearly 3 percent.)

Members whose health plan includes a savings or reimbursement account can keep track of fund balances.


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