Better Cost Transparency with Our Medical Cost Estimator

Imagine you are planning a vacation. You know where you want to go, and you know about how much you can afford to spend. It’s likely that your next step is to compare prices online for airline tickets and read hotel reviews before making a decision. Now imagine your primary care doctor says you need to see a specialist and may need surgery. You would like to make an informed decision, and it would be very helpful to know the expected costs. What do you do?

Because of its complex and unique nature, healthcare has struggled to keep up with the transparency consumers have come to expect from other industries. But Intermountain Health^® and Select Health^® believe that consumers, providers, employers, and agents are ready for more. Cost transparency has evolved beyond an industry buzzword to become the foundation of a new era in healthcare.

Related: Select Health Member Toolkit

It’s clear that providing credible resources and easy-to-understand information helps consumers make more informed decisions. Increased access to data provides opportunities for exploring and considering treatment options. Ultimately this type of knowledge sharing improves engagement, increasing the value of care for everyone.

Consider an individual on a High Deductible Health Plan (HDHP) with a health savings account (HSA). She is discussing the need for an MRI with her doctor. With no information, she will likely get the MRI—and the bill—regardless of the outcome. But if her doctor says the results of the MRI won’t change her treatment, or if she can compare costs at several different facilities and pay with her HSA, that knowledge may influence her decisions.

Providing transparent cost and quality data is a key way to improve healthcare. Here are three examples of how Intermountain and Select Health are making the complicated world of healthcare and insurance more transparent:

• Shared Accountability.

Arguably, one of the biggest issues facing healthcare today is the cost, which is why it’s frequently debated in political and private realms. In conjunction with Intermountain Health and affiliated providers, Select Health offers a plan called Select Health Share that involves four primary stakeholders: employers; employees; providers; and, the health plan. These stakeholders agree to be engaged partners in decisions that affect their health, their care, and its cost. This accountability does more than align financial incentives; it is a unique, sustainable partnership that aims to improve the quality of healthcare and help people live healthier lives while also providing predictable premiums and transparent costs. Perhaps most significantly, provider payment arrangements are moving from “fee-for-service” (based solely on the number and type of services provided) to “fee for value” (which includes payment based on quality, patient satisfaction, and total costs of care). This supports Intermountain’s broader focus and mission to helping people live the healthiest lives possible.  

• Medical Cost Estimator.

HDHPs have been a great way to encourage consumers to be more involved in their healthcare purchases. But you can’t just engage people financially; you have to provide the tools to make informed decisions. For years, consumers have been asking for a way to know ahead of time how much a medical service or procedure will cost, but the data has traditionally been scattered throughout many systems, not to mention the inability to link information to the specific provider or the member’s specific benefit plan. However, new technology and a changing industry—and a lot of computer programming—are finally bringing online cost lookup capability directly to consumers. The Select Health tool estimates how much a member will pay based on his or her unique plan benefits and network. Data from fee schedules can provide highly reliable estimates that represent the cost of care specific to a member’s plan, including deductible and out-of-pocket maximum. Cost estimates for common procedures include a breakdown of charges usually associated with the procedure, such as facility, surgeon, anesthesia, and more.

• Provider Reviews.

If you got a bad haircut or had a poor experience with a car repair, chances are that you’d find a different provider next time rather than choosing simply based on location. Healthcare is critical and personal, and most consumers appreciate finding a doctor who provides quality care and service, as well as someone they feel comfortable talking to about their medical concerns.

Select Health offers an online provider search tool that allows consumers to view patient satisfaction ratings of their providers. The patient rating score is a composite of physician-related questions on the Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS).* This survey is administered year-round; patients are called soon after their appointment with the doctor. Provider ratings, along with confidential and anonymous patient comments about their experiences, are included in the reviews.

Related: Getting an Annual Mammogram Could Save your Life 

It’s important for everyone who uses or provides healthcare to discuss goals, treatment options, and potential risks and benefits in a clear, meaningful way. Greater transparency and engagement is essential to the provision of high value, affordable, customer-centric care and services.

*CAHPS is a third-party agency that evaluates consumer and patient healthcare experiences.