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Shopaholics welcome: Insurer rewards members who hunt for best procedure prices


Price transparency is having a moment in the healthcare industry--particularly in the insurance sector, which has long faced criticism for contributing to consumers' less-than-adequate understanding of costs.

The good news is the Affordable Care Act exchanges have attracted a particularly savvy, cost-conscious breed of consumer. In response, insurers are stepping up their member-engagement game.

One of those insurers is Michigan-based Priority Health, which has taken its efforts to engage with consumers to the next level by rewarding them for shopping around for the best price for medical procedures and services.

"We want to make sure that consumers can know as much about healthcare as they can about everything else," Joan Budden, the company's chief marketing officer, says in an exclusive interview with FierceHealthPayer.

In addition, UnitedHealth's Optum360 unit and Mayo Clinic recently teamed up to streamline the prior authorization process, enhance claims editing functions and simplify administrative billing in order to "create a patient financial experience that is on par with Mayo Clinic's exceptional patient care experience."

And Health Care Service Corp. gave some of its members access to its Provider Finder with Cost Estimator, which helps them estimate treatment costs and find in-network providers.

Even the federal and state based insurance marketplaces have improved some of the tools that help consumers choose a health plan based on costs and other factors--though many still don't go far enough.

But offering these tools is one thing--getting busy consumers to actually take advantage of them is another. That's why Priority Health decided to make its members an offer it hopes they can't refuse: It rewards them with Visa gift cards ranging from $50 to $200 for using the company's cost-estimator tool to choose a fair-priced medical procedure.

"While everybody is talking about transparency, I don't think many carriers are going quite as far as we are," Budden says.

"We're trying to make people just more engaged in their health," she says. "And part of being more engaged is asking the question: What procedure are you recommending, why are you recommending, how much does it cost, who do you think is best. Just being aware of all those aspects before you get something done."

Besides the financial reward tied to it, Priority Health's price tool also is unique because it preprocesses members' claims based on their copay, deductible and other factors using its own contracts, not Medicare rates, Budden adds.

Priority Health launched the financial incentive program, called PriorityRewards, July 1, and come August, has seen a 30 percent increase in the number of people that are shopping with the price estimator tool.

"I think the word is starting to get out there," Budden says. "It's just starting to ... take off."

That may be because patients are often hard-pressed to obtain such information from their providers: As Transunion Healthcare President Gerry McCarthy told FierceHealthFinance, fewer than one-third of hospitals in the U.S. currently provide billing estimates.

Indeed, Priority Health has noticed that many physicians who make referrals aren't aware of the cost differences of where they're sending their patients, Budden says, so the insurer is trying to get doctors to use its price-estimator tool as well as consumers.

Regardless of who uses the tool, though, Budden adds that it's "the right thing to do in the age of consumerism where people have access to information in literally every other segment of our society--but somehow healthcare is a black hole." - Leslie @HealthPayer

Related Articles:
Michigan health insurer pays members to use cost-estimator tool
Transunion: Patients want clear bills and cost estimates, but few receive them
UnitedHealth partners with Mayo Clinic on revenue management, patient experience
Health insurance marketplaces improve consumer-friendly tools
Health Care Service Corp. launches price transparency tool