Sites for More Eyes
Online Sources Offer New Information About Doctors and Hospitals, and What It Costs to Use Them

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.

Pro: The hospital comparison feature provides important information for patients who may want to question their doctors on the choice of hospital.

Con: CareFirst says it has a treatment cost estimator, listing prices in 22 major categories, such as the treatment of infections, heart conditions and diseases, with additional estimates for the treatment of hundreds of specific conditions. Even though a spokesman described where on the site this estimator was located, this user could not find it.

What's ahead: CareFirst plans to add a "coverage advisor" next month to help direct members to plan types, based on their health status and other factors. CareFirst also promises more price and quality information on doctors in 2007.

Cigna

At http://www.cigna.com/ , Cigna offers its members tools to find pricing on 48 common inpatient, diagnostic and outpatient procedures, giving an estimated average cost of a specific procedure at a given facility. Even more impressive, the pricing is tagged to a member's specific policy, telling an individual what he can expect to pay out of pocket.

A search for total knee replacements among area hospitals, for example, shows that the procedure costs Cigna and its members $6,160 to $9,298 at Inova Mount Vernon Hospital, with an expected out-of-pocket cost of $1,516 to $1,830 for a member with a $1,000-deductible health plan and a 10 percent co-insurance obligation for inpatient services. The tool also provides ratings (one to three stars) for "cost efficiency" and "patient outcomes" at each hospital.

Meanwhile, a quick check to find the going rates for a CT scan shows a price of more than $1,000 at Providence Hospital and Reston Hospital Center -- more than three times the $280 price at Computed Tomography Associates, PC, and Clinical Radiologists. A Cigna member who has the coverage described above and who has already met his deductible would therefore pay $28 to more than $100 for this scan.

Cigna also offers members and prospective members a chance to estimate which type of Cigna plan is best suited for them based on personal details about their health and other characteristics.

Pro: The tools are tailored to members and their specific benefit plan. This makes the experience of searching for good treatment at a good price personal and powerful. As impressive as the pricing tools are for procedures, the drug price tool may be what saves the average member big bucks.

"When people talk about how can consumerism and transparency take costs out of the health-care system, here's a classic example," noted Cigna spokesman Joseph Mondy. "Once you see this, you'd never buy the brand-name version when you can save yourself, the plan and the health system so much money."

Con: Cigna runs caveats along with its pricing tools for inpatient and outpatient procedures: "Your actual costs may vary significantly from the estimated average cost figure provided." Moreover, the explanation behind the three-star quality rating system may lead to some head-scratching.

What's ahead: Cigna plans to bolster its physician data in 2007.

Kaiser Foundation Health Plan of the Mid-Atlantic

Like CareFirst, Kaiser offers members handy tools to track their medical care and refill prescriptions at http://www.kaiserpermanente.org/ , with a focus on staying well and managing chronic conditions. But Kaiser is playing catch-up when it comes to giving members cost and quality tools.

Pro: Kaiser's Interactive Health Plan Advisory prompts prospective and current enrollees with basic demographic, health-status and cost-preference questions that generate the type of plan -- HMO, PPO, CDHP, etc. -- best suited to the individual.

Con: Overall lack of pricing and quality tools.

What's ahead: Kaiser aims to unveil a tool this month to provide members with the cost of physician and some inpatient hospital services in metropolitan Washington. Kaiser also plans to provide its members with links to the National Committee for Quality Assurance and several other outside organizations that examine the quality of health plans, hospitals and doctors.

UnitedHealthcare

Members of UnitedHealthcare plans can sniff out deals at http://https://www.myuhc.com . Enrollees can estimate the cost of medical treatments, picking from 80 common hospital procedures and many other specialty procedures, with pricing based on Zip code.

Take shoulder surgery: The tool will break down the costs -- including anesthesia, surgery, radiology, professional and facility fees -- related to the procedure, contrasting in-network and out-of-network prices. The member can also see expected out-of-pocket costs.

Providers are awarded one or two stars for quality -- or none at all. (A zero-star listing indicates that the provider does not meet the voluntary standards set by his or her specialty society.) The hospital rating tool uses a three-star rating system, and members can drill down to look at the hospital's death and complication rates on specific procedures.

The pharmacy savings advisor allows a member whose information is already in the system to order drugs and show how much can be saved by choosing generics or ordering by mail.

A plan cost estimator allows people to key in demographic and health information -- to find which health benefit suits them best.

Pro: Cost estimates give a decent perspective about overall costs of treatment. Most tools are easy to use, and many can be tailored to a particular member.

Con: United's physician quality rating scheme tells little more than whether the specialist meets the parameters set by his or her respective medical society. A test drive of the plan cost estimator tool shut down a reporter's computer initially.

What's ahead: Next year, United plans to launch an integrated health card, which will contain key aspects of an individual's medical record. The wallet card can be swiped in a reader at a doctor's office to provide key medical information.

Medicare

Since the late 1990s, the Medicare program has been the trend-setter in providing consumers -- in some cases even those who are not Medicare beneficiaries -- with pricing and quality information in an easy-to-use format. Consumers can get information on nursing homes, home health providers, hospitals and dialysis facilities. More recently, the site ( http://www.medicare.gov/ ) has been carrying powerful pricing data, particularly on prescription drug costs.

Medicare officials now have created http://www.mymedicare.gov/ , a gateway for Web-savvy beneficiaries and their family members to access these quality and pricing tools, along with personalized information on medical and benefits history. Beneficiaries can also compare costs and benefits of traditional Medicare with the program's alternative plans, based on their health status. They also can look for doctors and specialists in their area.

Pro: Medicare's prescription drug plan finder allows beneficiaries to shop for the best price. Medicare has worked out the kinks the system displayed when it was launched last fall. The site allows individuals to see how their current drug plan stacks up against other options.

Con: Quality data on physicians is lacking. Also, the Hospital Compare tool, while a handy resource on hospital quality, rates facility performance only on the following medical conditions: heart attack, congestive heart failure, pneumonia and surgical infection prevention.

What's ahead: Medicare officials are working on providing quality information on specialists, but its release is not expected soon.

Federal Employees Health Benefits Program

The FEHBP has for several years offered online cost and quality information on health plans and insurance carriers at http://www.opm.gov/insure/health/index.asp . During this fall's open enrollment season, 8 million federal workers, retirees and dependents will find they have more access to hospital and physician quality and cost data than ever before, but only from a subset of providers. At least 18 of the more than 100 carriers that contract with FEHBP will offer varying degrees of provider pricing on such procedures as delivering a baby (including doctor and hospital charges), replacing a knee, caring for asthma and at least nine others.

Pro: Federal workers will see provider-level pricing this open-enrollment season, complementing FEHBP'S current Web-based pricing and quality resources.

Con: Workers have to be proactive to chase down a lot of quality information. For provider-level prices, for example, workers must visit the site of each carrier to ferret out the information.

What's ahead: Making the site more interactive with real-time information on cost and quality in 2007.

Subscription-Based Services

Subimo, WebMD and a handful of other Internet companies have created Web-based tools that can deliver cutting-edge, consumer-friendly health information. The firms sell those tools to health plans and employers, which offer access to the products to their members and employees.

Unfortunately, the companies make available to other consumers only a fraction of its decision-support tools, some free, some at a price:

HealthGrades Inc.

HealthGrades ( http://www.healthgrades.com/ ) allows free access to its hospital ratings to see a particular hospital's performance for 29 common procedures. Each hospital is rated on how it performs each procedure based on death, complication and other rates, taking into account severity of different patients' illnesses. HealthGrades charges $17.95 for an in-depth quality and cost report on a hospital. The company sells reports on individual physicians for the same price, and medical cost reports on specific procedures are available for $7.95.

Subimo

Subimo offers its Healthcare Advisor tool to consumers directly at http://www.myhealthcareadvisor.com/ , which allows consumers to find quality information on most of the nation's hospitals for more than 100 common procedures and conditions. A medical encyclopedia is also available. Cost: $24 a year.

WebMD

WebMD ( http://www.webmd.com/ ) also provides great medical and personal health tools to consumers. Unfortunately, consumers can access its pricing and quality tools only through certain health plans or employers.