How much are in-network provider fees and/or discounts?

[NewHealthStrategies]

I love this conversation.

Somarco (Bob) writes:Fee's are predetermined either on a per diem basis or discount. When consumers start shopping on price as the primary factor everyone loses. Will they fire their PCP when they find out the guy in the next building charges less? Or wil they keep the PCP but opt for the EDLP neurosurgeon? Transparency is nice when you are comparing where to get your oil changed. But when it comes to medical treatment, I fail to see the value.



Some of you might recall Health Market that came out about 5 years ago and the concept was to allow you (over the internet) to basically allow Doc's to BID for your office visit.

ALL CARRIERS report that consumer plans REDUCE utilization in the bad areas and INCREASE UTILIZATION on the good areas.... which, duh, tends to happen when you have some skin (money) in the game.

One of our (Bob and I's) MAJOR hospital systems is already seeing an major influx of people asking what the cost is (which they SHOULD).

I would concede that 3rd party data that is reliable is going to be needed instead of self-reporting and carrier input on the price alone. Quality and price will be MAJOR influences in the near future as more people move to HSA/HRA and higher deductible plans.

I would suggest there is MUCH empircal evidence to suggest that price shopping will have a huge impact on the medical community. In fact, I'm have spoken to a huge group of PHO doc's on just that topic and beleive me, everyone of them is very concerned about this.... as most don't know what it REALLY costs them to perform a specific procedure to begin with...

Since I've been doing Consumer plans for about 8 years and have worked with some major players in this game, every argument AGAINST it has fallen by the way-side.

It really doens't matter whether you THINK it will work or not..... it WILL BE the way we deliver health care for the next 10-15 years.

Hey Bob.... we've gone full circle back to the indemnity days...... God, I'm old.

 

[J.R.]

I like the way you think New Health and I agree with you. Open up everything to the market and let it rip.

Some of you might recall Health Market that came out about 5 years ago and the concept was to allow you (over the internet) to basically allow Doc's to BID for your office visit.

I love the idea. What happened to the program?

I would concede that 3rd party data that is reliable is going to be needed instead of self-reporting and carrier input on the price alone. Quality and price will be MAJOR influences in the near future as more people move to HSA/HRA and higher deductible plans.

Agreed. Anything that engenders capitalism is a good thing IMHO.

I would suggest there is MUCH empircal evidence to suggest that price shopping will have a huge impact on the medical community. In fact, I'm have spoken to a huge group of PHO doc's on just that topic and beleive me, everyone of them is very concerned about this.... as most don't know what it REALLY costs them to perform a specific procedure to begin with...

Why am I not surprised!

 

[NewHealthStrategies]

Don't quote me on the references here.. but HEALTH MARKET was started by a guy, I think his name was Steve Wiggins from Oxford Health Plans (great success story).

Anyway, he was way ahead of his time. His idea (and this was actually IN the marketplace for a few years)... was you could go to his website and type in your zip code and what you were looking for.....

Example: 30066 and Pediatrician Office visit. It would also bring up all the pediatricians in your zip code area and list the price of an office visit. You could then enter in your contact information and ask for an appointment on say, Thursday morning at 10 am.

NOW HERE IS THE COOL PART: The system would generate, I guess, an email to the physicians that had bookings available at that time and the physicians office could BID on your appointment request.

One Ped might say..... we have lot's of time available from 8-9 on Thursday and we'll discount our normal $100 office visit fee to only $80 if you'll book today. Another might say: I'll be happy to see you at 10 if you bring me all the Medicaid children you can fit into your car as well.... you get the idea......

Anyway.... I loved the bidding part. It feel apart because no one had skin in the game (everyone had co-pays) and could care less about bartering a bushel of game hens for a discount office visit. TODAY is a different story and I truly believe this is where we're heading.

About 3 months ago, I consulted with a large group of physicians that are sick and tired of dealing with carriers and manage care and wanted to know if a "boutique-style" practice made sense. Guess what they loved MOST about the concept.... the idea that they could MARKET themselves.

Before any of you launch into the "Put this reduces healthcare to price and doesn't account for quality" argument... ask yourself this question..... "How did you pick the last doctor you went too?"

I'd actually love to meet the person that says, "I investigated them thoroughly through the AMA, the Health Board and made sure they were credentialed by at least 5 of the 8 major carriers in my market and also had the doc testify in an avadavit that his morbidity rates were some of the lowest in the area.... after interviewing at least 4 of his colleges where he spent his residency and no less than 10 existing patients".

Health care and health insurance are two different things. One is about getting care and the other is about paying for that care. When you mix the two it is tough to navigate without getting lost... but my bet is on the old adage.... follow the money. When the money is in the hands of the utilizer, things will change and change quickly.