SummaryThere is increasing consensus that comprehensive transformation of the healthcare system cannot be achieved without the engagement of patients, their families, and healthcare consumers. One stream of thought is that arming consumers with actionable cost and quality data could activate them as partners in controlling healthcare costs, which are expected to grow from 17.4 percent of the U.S. economy in 2013 to 19.6 percent in 2024.1 Although evidence remains mixed, some studies have shown that when patients are given easily digestible cost- and quality-of-care data, they choose high-value options.2,3
At the same time, growing out-of-pocket (OOP) costs mean that patients increasingly have more skin in the game when it comes to seeking care. A recent study showed that, as of 2013, OOP costs constitute 9.6 percent of median household income, up from 5.3 percent in 2003.4 Studies of these real-world transitions have often demonstrated that greater financial accountability simply reduces use of all services-both high and low value.5 The combined impact is that the need for better guidance for healthcare consumers is greater than ever. Plans, providers, and independent vendors are racing to develop meaningful web-based transparency tools that can help patients and families make more educated healthcare decisions and be more engaged in their care. Just in the last few months, several innovative strategies were unveiled.
Healthcare Plan Cost- and Quality-of-Care Tools
Health plans are increasingly developing a variety of user-friendly comparison tools that are intended to help patients select in-network providers, procedures, and tests based on cost estimates and quality-of-care data.6 BlueCross BlueShield of Tennessee recently launched its Financial Planner tool, which uses claims data from over 20,000 of its in-network providers to offer users realistic cost estimates for over 1,400 common healthcare services.7 This tool customizes cost estimates based on a patient’s plan benefits, latest deductible balance, and choice of specific provider or facility. Quality data, including provider ratings and patient reviews, are provided alongside cost data; and users also have the option of comparing cost ranges side-by-side. UnitedHealthcare just announced that its Health4Me mobile application, developed in 2012, is now available for use by 4.4 million UnitedHealthcare Medicaid and Children’s Health Insurance Program beneficiaries across 17 states.8 As well as helping users find nearby providers, manage prescriptions, and check their claims, the Health4Me app provides patients with cost estimates and quality data for 520 medical services and 290 episodes of care.9 Developing transparency tools for low-income populations is especially important given the expansion of Medicaid beneficiaries under the Affordable Care Act, and this population’s low perceived access to information that can facilitate healthcare decision making.10
Cost-Effectiveness of Specialty Drugs Tools
Various cost and quality comparison tools geared specifically toward specialty care are emerging. For example, the healthcare analytics firm Truveris just launched a mobile application, OneRX, which helps patients calculate their prescription drug co-pays based on their insurance coverage as well as any available deals, such as manufacturer coupons and pharmacy discounts. 11 The National Comprehensive Cancer Network has also announced that it is developing a comparison tool, which will complement its published cancer treatment guidelines, intended to help patients compare the costs and benefits of various cancer therapies.12 The tool will score different medication options on a one-to-five scale based on five measures: price, effectiveness, safety, quality, and consistency of clinical data. Eventually, the goal is to incorporate the tool into hospital HIT systems.
Provider Rating Websites
In August, the well-known customer-review site Yelp has joined the crowded space of physician rating websites aimed at helping patients review and choose appropriate providers. With the help of ProPublica, a non-profit investigative news organization, Yelp is now adding Center for Medicare and Medicaid Services data from over 20,000 healthcare providers to its user-friendly review pages. The added information includes emergency room average wait times and information on patient readmissions and complications.13 The idea behind this partnership is to make publicly available government cost and quality data on healthcare providers more consumable and actionable for patients.
As we aim to create more engaged patients and saddle them with increased responsibility for the costs of their care, they need access to meaningful, actionable healthcare cost and quality information. However, an opposing stream of thought backed by some evidence argues that patients do not use this data to make more informed healthcare decisions, even when it is available. One solution is to enlist providers for help motivating their patients to use these tools. For example, some insurers -UnitedHealthcare and WellPoint-are starting to render these tools available to providers in the hope that they will incorporate them in their conversations with patients.14 Arguably, the use of these tools in patient-provider conversations could ultimately lead to better engaged patients, increased shared decision-making, and more patient-centered care.