price transparency webinar 7 14

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Healthcare Costs Exposed The Push for Price Transparency

Housekeeping

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SPONSORED BYHealthcare Costs Exposed - The Push for Price Transparency

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Jaclyn Schiff

ModeratorEditorial Programs Manager

Modern Healthcare

Healthcare Costs Exposed - The Push for Price Transparency

Welcome!

During today’s discussion, feel free to submitquestions at any time by using the questions box

A follow-up e-mail will be sent to all attendees with links to the presentation materials online

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SPONSORED BY

Lana DjordjevicSenior Manager, Product

DevelopmentPriority Health

Paul KnudtsonDirector, Patient Access

Saint Luke's Health System

Maureen MustardDirector of Healthcare

AnalyticsNew Hampshire Insurance

Department

Jaclyn SchiffModerator

Modern Healthcare

Healthcare Costs Exposed - The Push for Price Transparency

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SPONSORED BY

Maureen Mustard

Director of Healthcare AnalyticsNew Hampshire Insurance Department

Healthcare Costs Exposed - The Push for Price Transparency

Creation of a Claims Database

• 2003 – Legislation created Comprehensive Healthcare Information System (CHIS)

• “…the data shall be available as a resource for insurers, employers, providers, purchasers of health care, and state agencies to continuously review health care utilization, expenditures, and performance in NH and to enhance the ability of NH consumers and employers to make informed and cost-effective health care choices.” NH RSA 420-G:11-a Development of a Comprehensive Health Care Information System.

• Reports were created using the claims data that showed rising premiums and level utilization in the state.

• Legislators recognized a need for greater price transparency in the state

7/13/2016 Page 6

The start of transparency

• Rules went into effect in 2005, state first received claims data in 2006.

• Methodology was developed at the Insurance Department to show cost estimates using a bundled approach within a few months of receiving the data.

• A website was created to publish estimates for about 30 procedures in New Hampshire

7/13/2016 Page 7

NH Health Cost

• www.nhhealthcost.org website was originally launched in 2007 and revamped in 2016

7/13/2016 Page 8

Expanded Website

• Later in July, the website will have 100 cost estimates that include– Outpatient tests and procedures– Radiology– Laboratory services– Behavioral Health– Office Visits– Chiropractic Care– Physical Therapy– Sleep Studies– Dental Services

• Quality of Care Measures from National Sources

7/13/2016 Page 9

Product Innovation

• As of April 2015, approximately 79% of small group and 43% of large group fully-insured members in NH are in “site-of-services” benefit designs, which include incentives to use lower-cost providers

http://www.nh.gov/insurance/reports/documents/2015_annual_report_cost_drivers.pdf

• Seeing the data through NH HealthCost helps insurance carriers better understand market prices for health care services, encouraging competition.

7/13/2016 Page 10

Trend towards low cost providers

• Members covered by carriers that were not in low-cost provider option plans also shift to lower-cost settings

7/13/2016 Page 11

Marketing Efforts

• NHID hopes to increase public awareness of the website to further promote use of lower cost providers.

• Sharing the tool with providers in hopes that they share cost information with their patients when referring them for procedures

• Seeking input for consumers about savings and experiences using the website

7/13/2016 Page 12

Thank You

Contact Information

New Hampshire Insurance Department21 South Fruit Street, Suite #14Concord, NH 03301requests@ins.nh.govPhone: (603) 271-2261Fax: (603) 271-1406TTY/TDD: 1 (800) 735-2964

www.nh.gov/insurance

maureen.mustard@ins.nh.gov

www.nhhealthcost.org7/13/2016 Page 13

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Lana Djordjevic

Senior Manager, Product DevelopmentPriority Health

Healthcare Costs Exposed - The Push for Price Transparency

• Why transparency?

• Priority Health’s journey

• PriorityRewards

The score board

• Challenges and opportunities

Priority Health’s journeySummer 2013

Published actual price ranges through

partnership with Healthcare Bluebook

January 2015

Cost Estimator, member specific out of pocket

cost

July 2015

PriorityRewards

Search by doctor

Search by facility

The score board

• 9% Member engagement

• Issued over $350,000 in member Rewards

• More than $3.5M in savings

Challenges and opportunities• Consumer engagement

• Understanding member behavior and how they shop for care

• The price/quality conundrum

• Quality vs. patient ratings

• Variations in billing practices

• Transparency to the greater population

Please use the questions box on your webinar dashboard to submit questions to our moderator

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SPONSORED BY

Paul Knudtson

Director, Patient AccessSaint Luke's Health System

Healthcare Costs Exposed - The Push for Price Transparency

• Fully integrated health system in metropolitan Kansas City

• 10 hospitals, 1,200 physicians, 65 specialty services

• Locally owned, not-for-profit, faith-based for 130 years

• Reputation for innovation, quality and compassion

• World class cardiovascular disease outcomes research

• One of nation’s leading stroke reversal programs

• 10,000+ employees

• Serving patients in 65 counties in Missouri and Kansas

Saint Luke’s Health System

2

Saint Luke’s Health System

2

Pricing Transparency

• SLHS complies with all CMS, IRS and ACA regulations.

• SLHS received recognition from HFMA as an adopter of the

Patient Financial Communications Best Practices.

• For pricing transparency to be meaningful a personalized price

estimate is needed.

Why

• It is the right thing to do for our patients!

• Patients really don’t understand their benefits.

• Too late by the time the patient receives their statement.

• Patient complaints that someone should have told them how much to expect.

Scheduled Patient’s

• SLHS performs approximately 40,000 price estimates annually. • For patients with expected out of pocket responsibility.

• Exclude patients with a secondary.

• Exclude patients with Medicaid.

• Comments from patients when contacted about estimate responsibility. • “Thank you, I had no idea.”

• Lot’s of great feedback from patients that signed up for exchange plans.

• Patient Example. • Patient with a $5,000 deductible and did not know her deductible was so high.

• Patient elected to postpone her procedure until she could save some money to cover her estimated out of pocket costs on this elective procedure.

Price Shopper

• SLHS has a Customer Service team that will take calls, emails or letters

from patients requesting pricing information.

• A personalized price estimate is performed for each patient that contacts us

requesting an estimate.

• Website has information about how to contact the team, apply for

Financial Assistance and our pricing transparency policies.

Results

• Customer service score for the question, “My insurance matters and

financial obligations were clearly explained.”

YearYearYearYear TopTopTopTop BoxBoxBoxBox Percentile Percentile Percentile Percentile RankingRankingRankingRanking

2010 58.4% Not Available

2011 55.9% 73rd

2012 58.4% 79th

2013 57.2% 66th

2014 66.8% 99th

2015 70.8% 99th

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Q&A

Thank you for attending

Thanks also to our

panelists

Expect a follow-up email within two weekswith links to presentation materials andinformation about how to offer feedback.

For more information about upcoming webinars, please visit ModernHealthcare.com/webinars

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SPONSORED BYHealthcare Costs Exposed - The Push for Price Transparency

Lana Djordjevic

Senior Manager, Product DevelopmentPriority Health

Paul Knudtson

Director, Patient AccessSaint Luke's Health System

Maureen Mustard

Director of Healthcare AnalyticsNew Hampshire Insurance Department