The wave of healthcare reform has fed the need for healthcare IT services, but in ways that extend far beyond the electronic medical record. It stands to reason if you can comparison shop for toys this season, why can't you comparison shop for healthcare procedures and physician services? In fact, the rollouts of these types of tools continue and come in different shapes and sizes, and at their heart-analytics that put the power of transparency in the hands of the consumer. This health care quality and cost analysis software can be used to get consumers to assist in the process of reducing healthcare costs for all players in the delivery system.
IF Technologies, Lexington, Ky., based company, has built its business model on the change of command that wants the consumer to have this power. The company offers preferred provider organizations a way to get their participating employers to assist in healthcare cost reductions through its product called HealtheReports. " In-network prices among healthcare providers for the same procedure in your area are often different. The difference can be significant. HealtheReports provides the pricing, by provider, up front to empower you to find the best healthcare value," said Jim Freedman, CEO of IFT.
He explained that differences can range up to 300% in the expected radius of service, and this is backed up by a recent report by the government's General Accounting Office.
Butler Health Plan implemented HealtheReports over a year ago and has reported in the media significant cost reductions for their members as well as the health plan. The average cost for some procedures dropped 50%, with employees getting pickier about selections through the IFT web-based subscription tool. Butler Health Plan is a non-profit self-funded medical, prescription and dental plan serving over 20,000 people in 15 school districts in southwest Ohio.
Other PPOs have taken a similar approach, across the nation, including InterGroup Services Corporation, a PPO network serving Pennsylvania, New Jersey, Delaware, and West Virginia, and one of the nation's largest networks, First Health. "First Health's commitment includes a commitment to the best market price for our consumers, and this is an intuitive and personalized way to allow consumers to identify high-vale healthcare in a few clicks," stated Blaine Faulkner, Chief Operating Office/Chief Financial Officer of First Health upon signing.
This "reference pricing" is anticipated to be a trend that will drive pricing to more equilibrium over time in each and every market. 57% of all healthcare plans are self-insured, self-funded, and are a function of renting networks for their employees, so any plan to save money across the board is a plan that networks and employers want to embrace. 30% of all PPOs are hospital-owned. And, there are more than 440,000 PPOs and carriers today. Incentive-tiered modules for employees approved by the PPO and employer are part of the thinking to influence consumer change of choice. Indicators available through software-as-a-service products, like IFT, include wait time, professionalism, effectiveness of care, cleanliness, recommendations, and maps.
A mobile application by IFT is on the way to be unveiled at the January meeting of the American Association of PPOs, Setting the Pace: Transformation Strategies, on Jan. 29-31, 2012 in Amelia Island, Fla. Freedman indicated that of the employees that get to use their tools, there is a return on investment up to $350 savings per employee on just the top 30 most common procedures ordered by patients. After 18 months of data, PPOs can opt to have platinum reporting on what happened to claims in light of IFT.
But the vast majority of employers are still in the dark about offerings like IF Technologies, and rely on their employees to Google " highly findable" sites like Yelp, RateMDs.com, and vitals.com that contain patient-rated anecdotal information at best. Half of the sites include quality information, and only a third feature cost data, according to an American Journal of Medical Quality study published in November. Some of the larger health insurance companies continue to develop their own tools, such as Humana's MyChoice Tools (Comparison Tools) for comparing physicians, hospitals, and outpatient facilities. The number of clicks and IT complexity has impacted utilization in many of the products designed internally at insurance companies.
Some quality measure sites are featured by employers such as healthcarebluebook.com, owned by privately held CareOperative LLC of Brentwood, Tenn., which is customizable by ZIP code and estimates payments providers will accept from insurance companies, as well as Hospital Compare, which includes a variety of measures taken from Medicare.
Some specialty organizations are looking at creating their own repositories of data on quality for their physicians and constituents, such as the American Gastroenterological Association regarding colonoscopy providers.
Dawn Yankeelov, president of Aspectx, is a strategic planning consultant in the areas of marketing, PR, and competitive analysis for the healthcare and IT fields.