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8 Hartford Business Journal • January 18, 2016 www.HartfordBusiness.com FOCUS HEALTH CARE Insurers push price transparency innovation By John Stearns jstearns@HartfordBusiness.com H ealth insurers continue improving ways to inform their customers about the cost and quality of health care to empower better buying decisions, while also showing that most expensive care doesn't necessarily equate to highest quality. As more employers offer high-deductible insur- ance plans, consumer costs are increasingly front-of-mind for consumers. That cost shift, some experts predict, will increase demand for useful price and quality data. As a result, insurers are rush- ing to sate that demand. Anthem Blue Cross and Blue Shield, for example, recently announced it's offering a new price and quality tool to Connect- icut customers through a collabo- ration with Castlight Health Inc. Castlight offers software tools designed to help employers man- age healthcare investments and employees make better health- care decisions. Anthem has had about 90 cli- ents using Castlight tools, but is rolling out the program across the board this year, starting about summertime with its health exchange business in Connecticut and then rolling it out to group segments through the rest of this year and 2017. The companies are scaling up the transparency tool now, said George Lenko, staff vice president-client solutions within Anthem's marketing department. The Castlight product powering Anthem's price transparency tool aims to better integrate doctor, price and quality information in one place, making it more user-friendly with a goal of engaging consumers the way sites like those in retail do, Lenko said. "It pays to be a shopper; it pays to be informed," he said. "It's very easy to be a shopper in retail or other service industries," but that transition has been slower in health care with its various complexities, he said. "People shouldn't be passive participants in their own health care," Lenko added. Castlight will offer a mobile app for Anthem cus- tomers to access cost and quality information digitally, something other insurers already offer. Digital access is a key component of making health- care decision making easier. Now, for example, Anthem offers an option where if it finds another network provider that charges less for the same service and quality, it will call customers with the potential cost savings. While there currently are no plans to discontinue that call service, it wouldn't be necessary with a mobile app that sends information directly to consumers, Lenko said. Skeptical doctors Doctors, of course, have not always viewed price transparency and quality tools favorably, arguing that many rankings or ratings are arbitrary or don't accu- rately reflect a doctor's ability. That, however, hasn't stopped insurers from continuing to innovate in the space, especially as demands for cutting costs con- tinue to escalate. Hartford insurer Aetna has seen its consumer engagement with such tools rising, said Chris Riedl, Aetna executive director of institutional businesses strategy and product management. "More and more people are becoming familiar with these tools and utilizing them the same way they would shop for anything else," she said. "We're all making great strides, but there's more to be done to get people to be using these tools." Aetna has been tweaking its transparency tool over the last decade, she said. Its Member Payment Estima- tor, or MPE, was introduced in 2010 and uses Aetna's claim-adjudication engine to access the most current negotiated rates with providers in real time, she said. The tool bundles services and costs for a procedure — for example, fees for the doctor, anesthesiologist, facil- ity, etc. — into one price, taking the guesswork out of the total patient costs, she said. The service bundle also accounts for the customer's specific health plan, including deductible, co-insurance and health savings account, to provide a personalized estimate. The tool allows customers to compare costs for up to 10 providers at a time, and options for where the care can be received, she said. Aetna's latest price transparency innovation is Wellmatch, unveiled in 2015. It builds off the MPE and offers additional features and a more customized experience for users, including patient reviews, pro- vider and facility quality ratings, anonymous co-work- er recommendations and mobile-app access. Aetna plans to offer reviews in its MPE this year and add pharmacy transparency on the mobile app, Riedl said. Meantime, Bloomfield insurer Cigna last year added a language tool to its Health Care Professional Direc- tory, which includes cost and quality information. For example, not everyone knows a doctor who does colo- noscopies is a gastroenterologist, said Gabrielle Bois- vert, digital marketing manager for Cigna. "So we introduced this concept of natural language where a customer can type in 'colonoscopy doctor' or 'stomach doctor' and will get results for gastroenterolo- gist," Boisvert said. Cigna also provided more upfront clarity to custom- ers before they see a doctor, giving them choices of whom they can see and where to access care, she said. The cost, for example, for the same doctor doing a colonoscopy in a hospital versus an outpatient facility can be as much as $2,000. Cigna provides quality information on doctors and facilities, too, such as whether a doctor has an NCQA rating. Cigna also has its own quality rating, or Cigna Care Designation, which basically equates to a high- performing, lower-cost doctor, Boisvert said. It's not a patient-experience rating, she said. "It's more about: We know that this doctor doesn't overprescribe procedures unnecessarily, we know that he or she is high-performing, we know that he or she falls within whatever the cost criteria are for that Cigna Care Designation." The site also will say if the doctor is accepting new patients. For patients searching to see if a doctor is in network and perhaps not thinking about cost and procedures that doctor performs, Cigna has added a link to prompt additional customer inquiry. "Basically, what the link says is: Know before you go, view procedures and cost information," Boisvert said. When clicking on view procedures and cost infor- mation, "what you're going to get is access to a ton of great information, including all of the different types of procedures that doctor performs and the cost of those procedures," she said. "So that's kind of one angle into helping inform our customers about cost information because a lot of times their mental model around com- ing to the directory is not necessarily to get a cost, it's more about getting a list of who are the in-network doc- tors that I can go see?" When customers see their cost estimates, they can hit a link called "Show me the math" that breaks down how the cost was calculated in an easy-to-understand format, she said. n EXPERT CORNER Medical marijuana law leaves open questions for employers By Megan Y. Carannante and Rachel L. Ginsburg M ary Jane, a machine oper- ator, is battling breast cancer. During a routine drug screening, she tests positive for marijuana. The com- pany intends to ter- minate her because she violated its zero- tolerance, drug-free workplace policy. When the com- pany confronts Jane about the failed test, she responds that she is legally using medical marijuana for her chemothera- py-related pain and fatigue. She assures the company that she only smokes mari- juana during non- work hours and has never been "high" at work. The company believes Jane, but is understandably con- cerned that the residual effects of her marijuana use may pose a safety risk to herself and others while she is on the job. The question is: Can the com- pany lawfully terminate Jane for her marijuana use? Connecticut is one of 10 states and the District of Columbia that provides protections to employ- ees who are medical-marijuana users or authorized caregivers for users. Specifically, Con- necticut law prohibits employers from refusing to hire, terminate, penalize or otherwise discrimi- nate against an employee solely on the basis of his/her status as a medical marijuana user or care- giver. Employers, however, can still insist that employees refrain from using marijuana during work hours and can discipline any employee who is "under the influence" at work. In light of this law, Jane's employer is faced with a catch- 22. If the company terminates Jane for violating its drug- free workplace policy, it risks liability if Jane can prove she was not "under the influence" at work. On the other hand, if it does not terminate Jane, the company risks liability should she report to work "under the influence" and injure herself or others. The issue is compli- cated by the fact that "under the influence" is an entirely subjective concept and unlike a breathalyzer test for alco- hol, a drug test is not always a reliable indicator of whether or not an employee is "high" at work because traces of mari- juana remain in an individual's system long after its effects disappear. When terminat- ing employees, com- panies are typically guided by statutes, regulations and court decisions. In the brave new world of legalized mari- juana in Connecti- cut, the statutes are unclear, the regu- lations are silent, and the matter has not yet reached the courts. For example, in a case now pending in Massachusetts, Bar- buto v. Advantage Sales and Marketing LLC, a marketing employee using medi- cal marijuana for her Crohn's disease was terminated two days into her employment after failing a pre-employment drug test. The Barbuto lawsuit is the third of its kind to challenge the propriety of an employee termi- nation based on lawful medical marijuana use, the other two being in Maine and Colorado. The lawsuit in Maine settled before the court could issue a ruling. In Colorado, in the case of Coats v. Dish Network LLC, the Colorado Supreme Court ruled that Dish Network was within its rights to terminate Coats, a quadriplegic using medical marijuana for pain who failed a drug test, because marijuana remains an illicit Schedule I drug under the federal Controlled Substances Act. Connecticut employers should not rely on Coats, however, because Colorado, unlike Connecticut, does not have a statute offering express protections to employees who law- fully use or administer marijuana. Until such guidance exists, Connecticut companies are wise to educate management about the medical marijuana anti- discrimination law, revise their handbooks and policies accord- ingly, and train management in recognizing signs of impairment from marijuana use. n Megan Y. Carannante and Rachel L. Ginsburg are attorneys with Pullman & Comley LLC and have recently conducted semi- nars and webinars regarding the legal aspects of marijuana use in the workplace. George Lenko, staff vice president-client solutions, Anthem Chris Riedl, executive director of institutional businesses strategy and product management, Aetna Megan Y. Carannante Rachel L. Ginsburg