Shopping for Care and Getting Money Back

The key to helping people become informed health care consumers may be making it worth their while.

As a benefits administrator for one of San Antonio’s largest school districts, Sheila Frierson works the phone helping the district’s 9,000 employees with their health plan.

Six months ago, the tables were turned. Frierson’s primary care doctor ordered an ultrasound because he was concerned about potential scar tissue from prior abdominal surgery. Now she was the one who needed help navigating the health care system.

And in return for using her plan’s tool to find a quality, low-cost provider for the test, she earned $50.

A national movement is underway to encourage health care consumers to shop for care more like they would for any other high-dollar purchase. A growing number of employers have price transparency tools to help make their employees aware of the significant differences in prices that local providers charge for the same service.

When consumers choose lower-cost doctors and hospitals, they have lower out-of-pocket costs—and benefit costs go down for the employer.  But these incentives often aren’t enough.

Most Americans still aren’t price-shopping for health care services even though they overwhelmingly say they are aware of the wide variation in costs and don’t believe that paying more gets them better care, according to a recent nationwide survey.

The key to helping people become informed health care consumers may be making it worth their while.

Sheila Frierson got $50 from her health plan under a program intended to motivate health care consumers to shop around.

As Frierson discussed her options with a customer service representative at Blue Cross and Blue Shield of Texas, she learned she was eligible to receive cash back through the Member Rewards program for choosing a quality, low-cost provider in her network.

“I am in a single household but I care for my mother,” Frierson said. “I need as much money back in my pocket as I can get. The $50 came right when I needed it.”

Employers and health insurers are also experimenting with other ways to encourage people to shop for cost-effective providers. For example, some plans set a “reference price” for certain procedures. Members who choose a provider who charges more than that price are responsible for the difference.

One of the reasons people often don’t shop for lower-cost options is that they don’t want to disrupt their existing relationship with a provider, according to the survey, which was published in the August 2017 issue of the journal Health Affairs. Another, though, is simply that they’re not aware of how to get the information they need.

Frierson also used her plan’s transparency tool yet again when her doctor ordered an MRI of her neck. “Now I’m expecting $75 back, and it should be right in time for a cruise I am taking,” she said.

Frierson now encourages her colleagues to become informed consumers of care. “We shop for our cars and our shoes and everything else,” she said. “Why not for our care?”

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