In Part 1, we introduced Dr Dexter Campinha-Bacote, Medical Director for Aetna, and one of the folks responsible for that company’s pilot transparency program. Today, we conclude InsureBlog’s exclusive interview, and offer some thoughts on the program's benefits, and potential shortcomings.
7) One of my readers is concerned with "glass pockets;" that is, consumers looking only (or primarily) for the lowest price on procedures without regard to provider credentialing or success rates.
According to Dr Campinha-Bacote, all of Aetna’s providers are Board certified, and Aetna conducts frequent member surveys to determine the level of satisfaction each provider enjoys. Of course, the company isn’t responsible for the decisions that its members ultimately make.
8) As a follow-up to the last question, what safeguards are in place to prevent “upcharging?” For example, an expectant couple looking for the lowest price on L&D may not factor in services like anesthesia vs going for natural birth.
The negotiated rates that one sees on the website include only those procedures that the doctor provides in his office, and of course exclude outside lab charges, etc. If and when the whole transparency phenomenon expands, then the other pieces will come into play.
For now, though, the idea is to keep things simple, and thus post only the limited number of procedures done in-office.
The doctor also told me that all the numbers available on the site are posted in real-time; that is, the rates are all current, not based on 6 month old data. To some extent, this should help mitigate “upticking,” although this is still a concern.
Dr Campinha-Bacote couldn’t have been more gracious, or open. This whole program is so new, though, that there are a number of unanswered questions, which will hopefully be addressed as the program matures and expands.
Other carriers are watching, too: I’ve noticed an uptick of my own, in terms of hits from carrier websites to my previous transparency posts, and by requests for links to this interview.
Which is not to say that the program is without warts. As Dr Siegrist notes in the comments section of Part 1, “(b)y listing prices only (with no context of the rationale behind prescribed tests and treatment), patients are left with only big dollar signs.” And I think this is a valid concern. To a great extent, the biggest challenge confronting more widespread “buy-in” to Consumer Driven Health Care (CDHC) is the willingness of the consumer to actually take an active role in determining courses of treatment. This means, for example, getting on the web (using Google, or WebMD, or even Intellihealth) and researching the pro’s and con’s of various treatment options.
In some ways, this is counter-intuitive: on the one hand, we need to trust that our physician will steer us in the right direction, and on the other hand, we need to be willing to ask hard questions to determine if that is, in fact the case.
There is no question that this can be a valuable tool for those covered by any qualified reimbursement plan (HSA/HRA/FSA). At the same time, there is a danger that folks will lose sight of what’s truly important: their health. Making health care decisions based solely on the price of a service seems to me to be a dangerous sort of game.
Still, I find it encouraging that this tool is available (albeit on a very limited basis). As we saw in the QwikHealth model, there is a demand for this kind of upfront information:
The other day, I had occasion to call on a new prospect, a pediatricic practice to which I was referred. As I walked in the front door, I noticed a sign on the receptionist’s window: “Yes, we do ear piercing.” At first, I smiled at the apparent incongruity. But then I realized that this was simply a way for that practice to let its patients know of another service they provide. All that was missing was “Just $9.95 an ear.”
That day may soon be coming.