Health

24 HEALTH • Spring 2015 When Patients Turn to You, You Can Rely on AdCare ® Healthcare News of Western MA 5"w x 6.625"h A medical facility dedicated to addiction treatment, AdCare Hospital is New England's most comprehensive provider of alcohol and drug abuse services. Our Services Include: • Inpatient and Outpatient Care • Support Groups • Day and Evening Treatment • Community Service Programs Outpatient Locations: Boston, Quincy, North Dartmouth, Worcester, Warwick, RI West Springfield - 413.209.3124 (800) ALCOHOL www.adcare.com Visit our website to view current employment opportunities The payoffs of price transparency W ould getting paid for a medical procedure such as a colonoscopy make it a little less unpleasant? A state mandate that requires health plans to provide real-time prices for med- ical services to the public is leading to such incentives, creating a more engaged population of patients. In 2012, Massachusetts passed a health care cost-containment law that included a provision mandat- ing health care transparency. As part of that, health care providers and payers were required to find a way to continually make prices for medical services accessible to all. Massachusetts health plans met the challenge and, in October 2014, they became the first in the United States to include prices for medical procedures and tests on their web- sites. But transparency works best when consumers have financial skin in the game. Health insurers have tied the pricing information to new financial incentives for their mem- bers. For example, every time Fallon Health members choose a cost-effective provider over a more expensive option for their proce- dures and tests, they receive a cut of the savings. This means consumers are now active participants in the health care process. They can see how costs vary significantly among pro- viders for procedures and tests, such as lab work and MRIs, and choose accordingly. High-deductible plans and out- of-pocket expenses create an incen- tive for consumers to price shop for health care. The challenge is keep- ing consumers engaged in the pro- cess before and after deductibles have been met. Fallon's pricing tool, Fallon SmartShopper, is designed to do just that. Members "shop" online for their health care procedure at least 24 hours in advance of their care. Options are presented based on both price and geography, which allow members to compare the dif- ferences in cost among providers. When members choose a low-cost option, Fallon gives them the cost savings, which comes as a check in the mail ranging from $25 to $500. Rewarding members who take a more active role in their health-care decisions further encourages them to "shop" and choose wisely, result- ing in lower out-of-pocket costs and further financial rewards. This incentive is unique in Massachusetts, and taking advan- tage of it is completely voluntary. In addition, health care quality information is available on fallon- health.org from such sources as Leapfrog, Massachusetts Health Quality Partners (MHQP), Medicare and the National Committee for Quality Assurance (NCQA) to help members complete their decision. These sources offer provider-specific data on how well patients fared when receiving care at a hospital or from a primary care doctor. The Internet has made shopping easier and turned all of us into smarter consumers. Sites such as Amazon and Yelp have become hugely popular by offering lots of information and choices. There is every reason to believe that con- sumers can become as smart about choosing a medical procedure as they are about buying music or picking a hotel. In turn, educated consumers, making decisions in their own financial interest, will help create a health care system based on value, one that's more effi- cient and sustainable. Taking extra steps to ensure you're getting the care you need at a price you can afford is not always easy. Getting a bonus check in the mail after a test or procedure can help — an incentive trumped only by a clean bill of health. David Przesiek is chief sales officer at Fallon Health, based in Worcester. CONSUMER ADVICE By David Przesiek

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