Med-Vantage Launches Integrated Member Out-of-Pocket Cost Estimator

Med-Vantage® Inc — a healthcare software solutions company, offering innovative and distinctive solutions for consumer transparency, provider performance management, and personal health management — today announced the release of their Member Out-of-Pocket-Cost Estimator. BlueCross BlueShield of South Carolina is the first customer to launch the solution, delivering it as a standalone tool as well as integrating the members’ costs into their Doctor and Hospital Finder, built on the Med-Vantage HealthSmart Enhanced Provider Directory™, a web-based provider search tool.

The Out-of-Pocket Estimator is a web-based Med-Vantage cost analytic module that helps members understand “what is this going to cost me?” The Out-of-Pocket Estimator calculates an estimate of a member’s out-of-pocket expenses for a given procedure by applying the applicable real-time benefits of the member’s specific plan to the calculated cost range.

BlueCross is one of the first of the Blue Cross Blue Shield companies to run the Out of Pocket Estimator, based on the Blue Cross and Blue Shield Association’s National Cost Comparison Tool (NCCT) data, covering Association-defined treatment categories. This vital transparency information is fully integrated into BlueCross’ Doctor and Hospital Finder, which already provides their members with sophisticated hospital and doctor search capabilities as well as hospital quality data. “With consumers paying a larger share of healthcare costs than ever before, we felt that providing personalized cost information specific to a member’s plan and chosen provider was a critical next step,” said Laura Long, M.D., MPH and V.P. of Clinical Quality and Health Management for BlueCross.

Med-Vantage adds the Member Out-of-Pocket Estimator to its current list of clinical cost and quality analytics for a wide variety of transparency, member profiling, and provider performance measurement needs. Because most out-of-pocket calculators in existence today are designed for hospitals or providers at the point of service, they display cost information at the billing code level for a given provider – which members don’t understand. The Med-Vantage offering displays estimated costs for specific conditions, surgeries or procedures and is calculated based on a typical ‘service profile’ for the condition, surgery or procedure.  The service profile is a unique part of the Med-Vantage analytics engine that breaks a given procedure down into its components services and their associated costs, and then applies those costs against the member’s benefit structure. For example, the cost for a colonoscopy would include costs for the procedure itself, the anesthesiologist, and the actual facility providing the procedure room.

“With the growth in consumer-directed healthcare and the passage of healthcare reform, we’re seeing more and more payers seeking ways to aid members in their healthcare decision-making and planning,” said Peter Goldbach, MD, President and CEO of Med-Vantage.  “By adding the Out-of-Pocket Estimator to their provider directory, BlueCross BlueShield of South Carolina further extends their ability to engage consumers in actively managing their care and making choices that can significantly reduce their out-of-pocket costs.”

The Out-of-Pocket Estimator can be integrated into the HealthSmart Enhanced Provider Directory or be implemented as a stand-alone tool. In addition to applying costs to the Blue Cross and Blue Shield Association NCCT treatment categories, the solution also calculates estimates for 450 Med-Vantage-defined conditions, surgeries and procedures.

BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.


About Med-VantageMed-Vantage is software solutions company focused on driving improved healthcare by providing easy to use consumer transparency and provider performance management solutions that effectively engage users and support smart value-based choices. Founded in 2001, Med-Vantage is a California-based privately held company that is majority owned by a consortium of Blue Cross and Blue Shield licensees called BP Informatics, LLC. Plans participating in the alliance include Arkansas Blue Cross and Blue Shield, Blue Cross and Blue Shield of Florida (through its subsidiary Navigy, Inc.), Blue Cross of Massachusetts, Blue Cross and Blue Shield of North Carolina (through its subsidiary NobleHealth, Inc.), Health Care Service Corporation, and Highmark Blue Shield Inc

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