HealthSparq Acquires ClarusHealth to Become a Market Leader In Quickly Growing Healthcare Transparency Industry

SAN FRANCISCO, CA – HealthSparq, a leading healthcare transparency solutions provider, announced today that it has acquired ClarusHealth Solutions, a leading healthcare provider search vendor. The companies will combine and extend their current transparency and healthcare shopping solution offerings. Together, HealthSparq and ClarusHealth will provide health plans and employers with a robust and integrated healthcare shopping platform, allowing their members and employees to make informed healthcare decisions, ultimately incurring lower costs.

The combined organization will be a market leader in the integrated transparency and healthcare shopping space, providing solutions and tools to 60 different health insurance plans that together provide coverage for more than 60 million individuals. Continue reading

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

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.

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

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

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

Docs and Patients Now Have More Ways to Get CIGNA’s Real-Time Itemized Cost Estimates

BLOOMFIELD, Conn., November 09, 2010 – CIGNA (NYSE: CI) announced today that it will expand access to its CIGNA Cost of Care Estimator® through four of the largest health information networks in the U.S.: Availity, NaviNet, Passport Health Communications Inc. and RealMed (an Availity Company). These companies service 90 percent of America’s physician practices, hospitals, and clinical facilities.

“The CIGNA Cost of Care Estimator is delivering on our promise to both our contracted physicians and our customers to make our health plans transparent,” said James Nastri, CIGNA vice president of product and service transparency. “By opening access to Estimator through the nation’s largest health information networks, we can help more individuals understand their plan coverage and address any cost issues upfront, so that both doctors and patients can focus on improving health rather than worrying about potential financial unknowns after the fact.”

Since it was launched nationwide in April 2009 on the CIGNA for Health Care Professionals website, (, the CIGNA Cost of Care Estimator® has delivered real-time, pre-care itemized estimates of specific treatment charges and payments for 21,000 health care professionals. The Estimator’s Explanation of Estimate provides a simple, clear explanation of the key elements of payment for medical procedures and treatments and is designed to correspond with the award-winning CIGNA Explanation of Benefits.

Sekine, Rasner & Brock OB/GYN Practice Administrator Judi Lento says she prints out a CIGNA explanation of estimate for every CIGNA-covered patient: “The estimate really makes the whole process simpler for both our office and our patients. It is essential for defining the treatment, coverage and any potential out-of-pocket costs up front — so there’s no guesswork, confusion or administrative issues. Our patients really appreciate getting accurate information in advance, and the CIGNA Estimator has helped our practice save hundreds of thousands of dollars.

“The Estimator approach is truly revolutionary because unlike real-time claims adjudication, it does not require purchasing technology and re-keying information into our practice management system,” said Lento. “Because we will now be able to access CIGNA’s estimates through a multiple payer system, our office flow will be even better than before.”

The CIGNA Explanation of Estimate provides the key information individuals need to know about how their CIGNA medical benefits are applied to their physician’s services:

  • Total Cost: Estimation of the total cost of services, including both the amount to be paid by CIGNA and the amount the covered individual will owe;
  • Patient Cost: The anticipated amount covered individuals will owe after their plan benefits are applied to the estimated total cost, including any deductible, coinsurance, or co-payment;
  • Potential Fund Payment: This displays the estimated amount to be paid automatically to the health care professional at the time the estimate is run from available funds in the covered individual’s Flexible Spending Account (FSA), Health Savings Account (HSA), or Health Reimbursement Arrangement (HRA) as well as any additional funds that may be owed. Ninety-two percent of individuals enrolled in CIGNA’s consumer-driven, account-based health plans have opted for automatic claims payment.

Beginning in the fall of 2010, health care professionals have the additional option of producing estimates for their patients enrolled in CIGNA health plans in targeted markets using:

  • Availity, a health information network supporting the exchange of more than one billion transactions per year on behalf of more than 200,000 physicians;
  • NaviNet Network, America’s largest health care communications network that connects 70 percent of the nation’s physicians to leading health plans and information for 121 million insured patients;
  • Passport Health Communications Inc., eCare Patient Access Suite includes revenue cycle software and services to help health care organizations verify patient demographic and insurance information, maintain payer compliance and accurately estimate and collect patient payments. Passport OneSource is used by one-third of all U.S. hospitals.
  • RealMed, an Availity Company, delivering revenue cycle management solutions to more than 30,000 health care professionals and processing more than half a billion transactions per year.


CIGNA (NYSE:CI), a global health service company, is dedicated to helping people improve their health, well being and sense of security. CIGNA Corporation’s operating subsidiaries provide an integrated suite of medical, dental, behavioral health, pharmacy and vision care benefits, as well as group life, accident and disability insurance, through 60 million customer relationships with individuals in the U.S. and around the world. To learn more about CIGNA, visit To sign up for email alerts or an RSS feed of company news, log on to Also, follow us on Twitter at @cigna, visit CIGNA’s YouTube channel at and listen to CIGNA’s podcast series with healthy tips and information at or by searching “CIGNA” in iTunes.

Capital BlueCross Launches Program Allowing Members to Evaluate Total Cost, Quality of Care for Specific Procedures at Various Facilities

Capital BlueCross continued its commitment to educating and engaging members about health care decision making by launching MyCare Advisor (SM), which is an online suite of transparency tools that assists people in understanding and comparing cost, quality and satisfaction among providers. More specifically, this enhancement to existing tools provides estimated total cost information for 57 of the most common elective services at hospitals, ambulatory surgery centers and imaging centers.

MyCare Advisor is simple to access and use. Members just need to log into the secure member portal at, click on the MyCare Advisor link, choose a procedure category and select a ZIP code.  Once this is completed, all of the facilities that meet certain criteria for the selected procedure will be displayed for review and comparison.

Information available to members will include cost ranges; the name and contact information for each facility; the network the facility is participating in; whether or not the facility has a Blue Distinction Center of Excellence designation; and the number of procedures performed annually at each facility. The cost estimate information is derived from Capital BlueCross’ claims data. By January the tool will provide information both locally and nationally.

“With the current health care climate, more and more people are taking ownership in the decision-making process for their own treatments and procedures, and we want to help them with this process,” said Bill Lehr, president and CEO of Capital BlueCross. “Most people comparison shop for anything from groceries to a new car, but most don’t realize that for routine procedures, like MRIs, X-rays or mammograms, there can be a wide variance in costs.  Knowing there is a difference is the first step in becoming an engaged health care consumer.”

Capital BlueCross is the leading health insurer in its region, providing health insurance coverage to nearly one million people in central Pennsylvania and the Lehigh Valley.

Capital BlueCross is committed to making health insurance simple for its customers and members through all the stages of life by offering nationally acclaimed customer service and a full range of innovative benefit programs for groups and individuals at competitive prices. Capital BlueCross received a high honor for its service by ranking highest in Member Satisfaction among all commercial health plans in the Pennsylvania Region, according to the 2010 J.D. Power and Associates National Health Insurance Plan Study. J.D. Power and Associates

By establishing a culture of caring, Capital BlueCross constantly strives to do more in order to deliver more for the men, women and children who depend on the company for their health insurance needs. Capital BlueCross has been providing health security to the people and communities of central Pennsylvania and the Lehigh Valley for more than 70 years and employs about 2,000 people in the region.

Headquartered in Harrisburg, Pa., Capital BlueCross is an independent licensee of the Blue Cross and Blue Shield Association.

More information about Capital BlueCross and its subsidiaries can be found by going to

SOURCE Capital BlueCross

Humana Named Top Payer For Second Consecutive Year

For the second year in a row and third time in five years, Humana Inc. (NYSE: HUM) ranks #1 in overall performance – making it the easiest payer for health care providers to do business with – in a review of 2009 claims-payment data conducted by athenahealth Inc., a provider of Internet-based business services to doctors, and Physician’s Practice magazine.

athenahealth and Physician’s Practice®, a leading practice-management journal for physicians, conduct the rankings annually to grade insurance companies on their transactions with physician offices. The complete 2010 PayerView Rankings, evaluating nearly 140 national, regional and government payers across the U.S. can be found at

“We are honored to be named the nation’s top payer for the second consecutive year by athenahealth,” said Bruce Perkins, senior vice president of healthcare delivery systems and clinical processes at Humana. “We remain committed to investments in technology that drive efficiencies, reduce administrative costs and improve customer service. Humana and athenahealth share common goals to drive innovation that creates cost-saving business transactions for health care providers, while also reducing fraud and waste in the system.”

For example, in tandem with athenahealth, Humana offers solutions such as real-time adjudication, which enables health-plan members to have a claim processed instantly before leaving the doctor’s office – which is good for all parties involved.

“The good news from athenahealth today is that Humana is continually paying physicians more quickly and accurately than our competitors, while also improving on our own company performance year over year, which results in an increasingly improved experience for our members,” Perkins said. “We take a lot of pride in that and we devote a lot of time, resources and effort into making it happen.”

Data for the 2010 rankings was derived from athenahealth’s web-based practice-management platform, athenaCollectorSM, and ranks health insurers in areas of:

  • Financial performance
  • Administrative performance, and
  • Medical-policy simplicity

The data athenahealth analyzed came from more than 23,000 health care providers in the U.S., roughly 39 million transactions and $7 billion in charges in services billed in 45 states for the full year 2009.

Humana improved across all metrics in the ratings, including dropping its “days in accounts receivable” by nearly 16 percent to an industry-leading 22.4 days. Since the ratings began five years ago, Humana has improved its performance on this metric by more than 25 percent. It is one of the most heavily weighted measures in the athenahealth rankings.

“Clearly, with its top finish three years out of five now in the athenahealth PayerView Rankings, Humana is committed to being the easiest payer for physicians to do business with,” said Jonathan Bush, chief executive officer of athenahealth. “Humana knows that this performance translates into better relationships with the medical community and more satisfied health-plan members.”

The rankings were published today on the Physician’s Practice website, in the publication’s June issue, and on athenahealth’s website.

Humana Inc., headquartered in Louisville, Ky., is one of the nation’s largest publicly traded health and supplemental benefits companies, with approximately 10.4 million medical members and approximately 7.2 million specialty-benefit members. Humana is a full-service benefits solutions company, offering a wide array of health and supplemental benefit plans for employer groups, government programs and individuals.T

Health Alliance Medical Plans Selects Treatment Cost Calculator from Thomson Reuters to Help Its Members Make Well-Informed Healthcare Decisions

Health Alliance Medical Plans, a provider-sponsored health insurer in the Midwest, has licensed Thomson Reuters Treatment Cost Calculator, an application that tells health plan members how much they will pay out-of-pocket for upcoming healthcare services.

The Treatment Cost Calculator generates cost estimates based on a health plan’s claims data at the provider level, so the estimates reflect plan payments to providers. These treatment estimates are then personalized for the member using real-time benefit information in order to provide relevant, accurate information.

With this information, health plan members understand their expected costs and how these costs vary by provider, a key consideration in their healthcare decision-making.

“Consumer-driven healthcare translates into consumer need for information,” said MaryAnn Tournoux, vice president of sales and marketing for Health Alliance. “This solution will help our members better understand their benefits and estimate their costs before receiving healthcare to avoid surprises and engage people in fully understanding their options.”

“Healthcare consumers need accurate, detailed information specific to their financial and medical circumstances,” said David Crean, senior vice president for the Healthcare & Science business of Thomson Reuters. “Health Alliance is providing that information to its members and supporting a growing market need for reliable information at the provider level. We’re honored to be a part of this solution.”

The Treatment Cost Calculator is part of Consumer Advantage™, a suite of online solutions from Thomson Reuters. For more information:

About Thomson Reuters

Thomson Reuters is the world’s leading source of intelligent information for businesses and professionals. We combine industry expertise with innovative technology to deliver critical information to leading decision makers in the financial, legal, tax and accounting, healthcare and science and media markets, powered by the world’s most trusted news organization. With headquarters in New York and major operations in London and Eagan, Minnesota, Thomson Reuters employs more than 50,000 people and operates in over 100 countries. Thomson Reuters shares are listed on the Toronto Stock Exchange (TSX: TRI.toNews) and New York Stock Exchange ( TRINews). For more information, go to

About Health Alliance Medical Plans

Health Alliance Medical Plans is a leading provider-sponsored health insurer in the Midwest, administering health plans more than 310,000 members in Illinois and Iowa. Health Alliance is one of ‘America’s Best Health Plans’ and named the top plan in Illinois in the most recent U.S. News and World Report and National Committee for Quality Assurance (NCQA) rankings of commercial and Medicare health plans. Additionally, because of an exceptional commitment to quality, Health Alliance has maintained the highest accreditation possible from NCQA for its HMO, POS and Medicare HMO plans since 1997.

SOURCE Thomson Reuters

Is it Possible to Find Out What Surgery Will Cost Before the Surgery?, a leader in helping patients obtain fair prices for medical procedures, surgeries and treatments, wants to know if it is possible for patients to find out what surgery will cost before the surgery. So, as part of Healthcare Blue Book’s ongoing effort to learn more about how patients can obtain pricing before agreeing to a surgery, their researchers regularly conduct pricing studies with medical providers.

In a recently published white paper, Surgery Pricing Secrets: The Challenges Patients Face, Healthcare Blue Book queried hospitals and Ambulatory Surgery Centers (ASCs) in three demographically disperse markets. These were Raleigh-Durham, North Carolina; Denver, Colorado; and Portland, Oregon. Researchers sought to obtain prices for self-pay patients, who did not intend to use insurance to pay for the procedure.

Healthcare Blue Book research focused on the ease of obtaining a price quote from a facility prior to receiving treatment. The evaluation included several categories, including how to:

  • Find someone who could answer pricing questions
  • Get a price quote within a reasonable amount of time
  • Obtain a complete price quote for all parts of a surgery
  • Ask for and obtain a cash discount
  • Get a guaranteed price estimate

The researchers found that while many hospitals attempt to help patients figure out what surgeries will cost, it’s still uncommon to obtain guaranteed prices from them before a surgery. Although many hospitals have created a staff position called “patient financial counselor,” patients frequently have a frustrating and unproductive experience. In contrast, ambulatory surgery centers (ASCs) provide far greater pricing transparency to patients and do so in a patient friendly manner in most cases.

The primary conclusion reached from the research is that healthcare pricing transparency is not possible under the current practices and pricing policies of most hospitals and some ASCs.

Healthcare Blue Book suggests six steps consumers can take to make sure they get a fair price for their surgery:

1. Ask your surgeon for the CPT code for your procedure before researching surgery pricing.

2. Call multiple providers from different types of facilities.

3. Ask for all costs associated with a surgery (surgeon, facility, anesthesia, hardware, etc).

4. Get pricing estimates in writing.

5. Consider out-patient alternatives to hospitals whenever possible.

6. Be patient and persistent when conducting pricing research.

The Healthcare Blue Book is provided free to consumers. The Healthcare Blue Book price represents a fair price to pay for a service or product when the patient is paying cash at the time of treatment. It represents a payment amount that many high-quality providers accept from insurance companies as payment in full, and it is usually less than the stated “billed charges” amount. Visit

Blue Shield of California Launches Online Ratings & Reviews Program.

Blue Shield of California announced the launch of a first-of-its-kind initiative called Ratings and Reviews, which allows members to provide candid, public feedback about their experiences with Blue Shield’s plans. The program gives Blue Shield of California members a platform to share their opinions about the different plans, and will allow potential members to get tips and advice about choosing the right plan for their needs. The new program is already available to some members, and early feedback can be seen at

“Our members want to be heard and want to be able to interact with us and with each other in exciting new ways. We plan to address any issues raised in these forums openly to help our members get easy access to quality and affordable health care,” said Rob Geyer, senior vice president of customer operations at Blue Shield of California. “We’re proud to be the first health plan in the country to be fully transparent and encourage our members to share their health care experiences online in a richer and more visible way.”

Members can rate their Blue Shield health plan and read other members’ reviews by logging in to their account. The “rating” section uses a five star scale to measure overall satisfaction, customer service, value, doctor access, prescription drug coverage and whether or not the plan is easy to use and understand. The “review” section offers members an area to write in comments, advice and suggestions.

The Ratings and Reviews program is the latest in a series of initiatives that the not-for-profit health plan has undertaken to allow Californians to voice their recommendations about improving care. In 2007, Blue Shield’s “Chat Boxes” program gave Californians a chance to speak their mind in front of TV cameras – and resulted in new stand-alone dental products, improved online tools for finding a provider and applying for insurance and broader multi-language capabilities, among many other improvements.

About Blue Shield of California

Blue Shield of California, an independent member of the Blue Cross and Blue Shield Association, is a not-for-profit health plan dedicated to providing Californians with access to high quality care at a reasonable price. Founded in 1939, it now has 3.4 million members, 4,800 employees, one of the largest provider networks and more than 20 office locations, providing a wide range of commercial and government products throughout the state.
Source: Blue Shield of California