Category Archives: Transparency

Cigna and Safeway Reference-Based Pricing Study Shows Employee Education and Online Shopping Tools Can Help Control Lab Costs

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BLOOMFIELD, Conn. & PLEASANTON, Calif.–()–A study conducted by Cigna (NYSE: CI) and Safeway Inc. (NYSE: SWY), published in the December issue of the American Journal of Managed Care, shows that reference-based pricing can help control lab costs when individuals are supported with education and an online shopping tool.

“The understanding of reference pricing along with adoption of online tools to inform the consumer has increased significantly since the early days of 2011. Thoughtful application of reference pricing warrants consideration as a mechanism to improve value in health care and help individuals reduce their costs for certain services.”

The study, “Reference-based Pricing: An Evidenced-based Solution for Lab Services Shopping,” is the first published reference-based study to focus on lab services. Previous published studies have focused on the application of reference-based pricing to pharmaceuticals.

Reference-based pricing is a benefit design that sets a maximum contribution (reference price) from the health plan to pay for a particular service; in this case, lab services such as a lipid panel, comprehensive metabolic panel or prostate-specific antigen test. Employers see this type of benefit design as a way to incent employees to consider the price of services when making care decisions. Employees reap a savings when they choose services at or below the reference price. If they choose services above the reference price, they are responsible for the additional cost. Continue reading →

PwC’s Health Research Institute Identifies the Top 10 Health Industry Issues for 2014

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NEW YORK, /PRNewswire/ — Implementation of the Affordable Care Act (ACA) is only one of the factors forcing a rapid reshaping of the $2.8 trillion U.S. healthcare industry in 2014 according to PwC’s Health Research Institute (HRI). In its annual report on the Top Health Industry Issues for 2014, PwC’s HRI identifies the top 10 issues facing the U.S. health sector this year, including the need to adjust to empowered consumers, rapid innovation, and increasing competition from non-traditional players. The report includes the results of a survey of 1,000 U.S. consumers and interviews with health industry leaders that provide insights into the emerging new health economy.

The report notes that much of the health industry has accepted that reform is here to stay – and forward-looking executives are making decisions based on a post-ACA landscape that has altered the provision of insurance and the delivery of care. Continue reading →

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BCBSM to Compare Michigan Hospitals Costs and Care

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DETROIT—Blue Cross Blue Shield of Michigan, Blue Care Network, and the University of Michigan Health System have launched the Michigan Value Collaborative, an initiative aimed at helping hospitals across the state understand their practice patterns compared with their peers, better manage costs and improve outcomes for patients.

“This new initiative uses health care claims data to enable hospitals to see how they compare on the resources they use to deliver care to patients,” said David Share, M.D., M.P.H., senior vice president, Value Partnerships, Blue Cross Blue Shield of Michigan. “This initiative is unique in that it allows participating hospitals to see how they compare with other hospitals, and use that data to better connect their care practices and costs with outcomes. Hospitals will be able to adjust their practice patterns to benefit patients and the overall efficiency of our health care system.”

See the full story at BCBSM.com.

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As Some Companies Turn to Health Exchanges, G.E. Seeks a New Path

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Some major firms, like Walgreen, the drugstore chain, are giving those who qualify money to buy insurance on a private health exchange. In Cincinnati, General Electric is taking the opposite approach to reining in health care costs

One of the largest employers in the nation, it spends more than $2 billion a year offering coverage to 500,000 employees and retirees and their families. And it is using its considerable clout in places like this — where its giant aviation business gives it a major presence — to work directly with doctors and hospitals to improve care and reduce costs.

Over the last few years, G.E. has pushed for the creation of so-called medical homes, in which an individual medical practice closely coordinates a patient’s care by having access to all of the patient’s medical records.

In Cincinnati, about 118 doctors’ practices have converted to medical homes, and all five of the major health systems are making their primary care practices move in that direction. G.E. has also pushed for greater transparency of results.

See the full story at NewYorkTiems.com.

 

 

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Blue Cross and Blue Shield of Minnesota Announces the SmartSelect Online Health Care Shopping Tool

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EAGAN, Minn., Sept. 18, 2013 /PRNewswire-USNewswire/ — Today, Blue Cross Blue Shield of Minnesota (Blue Cross) announced that SmartSelect™, the first in a family of online health care shopping tools, is now available as part of its standard benefits package for all members. This tool helps address rising health care costs by encouraging members to become more informed health care consumers.

BlueCross is partnering with Change Healthcare, a market leader in consumer engagement and cost transparency tools the SmartSelect tools.

See the full story at PRNewswire.com

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App Helps Consumers Navigate New Healthcare Landscape

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CareOptions is a completely app-based, cloud-accessed Family Healthcare Advisory Program that vendors provide as a benefit to their employer groups, customers and prospects.

CareOptions memberships,… are essentially…  special access to exclusive care planning tools, cost-of-care evaluators, healthcare answers and document sets that can save them [consumers] significant time, money and stress when facing health, wellness or caregiving issues.

See the full story at Virtual-Strategy.com

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California Public Exchange to Delay Quality Rating System

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Covered California has decided not to include a quality rating system for health plans when the new insurance marketplace kicks off enrollment in October.

The issue has been controversial because some plans have complained there is not enough time to prepare their reporting systems to track the requested data.

Read the full story at bizjournals.com

 

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Two States Tackle Price Transparency

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North Carolina and New Hampshire are taking similar paths regarding healthcare price transparency, with both states determined to make such data more readily available to consumers.

In North Carolina, Gov. Pat McCrory has signed a bill into law that requires hospitals to publicly report what they charge for the 100 most frequent reasons for admission, the Raleigh News & Observer reported. Hospitals and ambulatory surgery centers must also report pricing information on the 40 most common surgical and imaging procedures.

In New Hampshire, legislation has been introduced that would require all providers–whether hospital, outpatient center or physician office–to provide prices to uninsured patients of the 25 most commonly performed procedures, the Concord Monitor reported.

Read the full story at FierceHealthFinance.com

 

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