Posts Tagged ‘Doug Ghertner’
Change Healthcare Q4 Healthcare Transparency Index Shows Widely Varying Prices for Healthcare Services, Reinforces Need for Transparency
HCTI Shows High Price Variability on Imaging, Birth Delivery and ACA-Mandated Preventive Services
BRENTWOOD, Tenn. (May 6, 2014) –Change Healthcare’s latest quarterly Healthcare Transparency Index (HCTI) shows nine medical procedures with high costs and price variances as high as 796 percent. Even within a given network, charges for pharmacy, medical and dental services often vary by more than 300 percent.
“As patients are paying a larger share of their medical expenses – a result of higher co-pays and high-deductible health plans – the need for cost transparency on a consumer level becomes ever more essential,” said Doug Ghertner, president and CEO of Change Healthcare, the market leader in consumer engagement and cost transparency. “Providing patients with the education and information they need to make value-based healthcare decisions benefits the individual and plan sponsors alike.”
Imaging services were the leading area for cost reduction opportunities for plan sponsors and consumers. From an analysis of a database including more than 180 million insurance claims from Q4 of 2013, Change Healthcare found CT scans varied 796 percent from $307 to $2,747 per scan, with an average cost of more than $1,200. Ultrasound costs varied by 411 percent.
Report findings also included inconsistent pricing for vaginal and cesarean section (C-section) deliveries. Vaginal deliveries, ranging 189 percent from $4,359 to $12,613 per delivery, were labeled as a high-cost and high-variance service. Meanwhile, as the prevalence of C-section deliveries increases – 60 percent since 1996, according to The National Center for Health Statistics – so does the variation in cost, which currently spans from $6,680 to $17,619 per procedure.
Five preventive services mandated by the Affordable Care Act (ACA) and provided without charge to consumers were named in the report as opportunities for targeted interventions, particularly among the public and private insurers and employers who are now absorbing all costs associated with these tests and procedures. A standard office visit with a diabetes screening ranged in price by 300 percent, while a screening mammogram showed a 193 percent price variation. Other mandated services included in the report include a screening colonoscopy (189 percent price variation), office visit with lipid screening (183 percent price variation), and an office visit with pap smear (93 percent price variation).
To uncover services with the greatest opportunity for savings, Change Healthcare’s HCTI includes a Transparency MatrixTM, which identifies services that are both high cost and highly variable in price. Examining data from the fourth quarter of 2013, nine services fell into the Change Healthcare Transparency Matrix Target quadrant. The nine services included:
|Service||Price Range||Price Variability|
|Colonoscopies/Upper GI Endoscopies||$1,379-$4,242||
|Office Visit with Lipid Screening||$185-$523||
|Office Visit with Diabetes Screening||$121-$485||
The HCTI report, available at http://www.changehealthcare.com/resources/publications/hcti, is a quarterly measure of the costs and cost variability of various medical and dental services that consumers purchase on a recurring basis over time. The source of the healthcare cost data is the aggregation of in-network medical and dental claims from credentialed providers across all Change Healthcare clients, which has geographic coverage that spans nationally and covers more than 7 million lives.
About Change Healthcare
Established in 2007, Change Healthcare is on a mission to transform the way Americans purchase and utilize healthcare services by driving sustainable engagement at the individual level. With a national client base of health plans and employers covering lives in all 50 states, and more than 7 million users on its platform, Change Healthcare is the premier national provider of healthcare cost transparency and consumer engagement solutions that enable consumers to: Better understand and utilize their healthcare benefits; make informed healthcare purchasing decisions based on quality, cost and convenience; and manage higher out-of-pocket responsibility and realize savings. This, in turn, helps plan sponsors: Control their healthcare cost growth trend; successfully migrate to more cost-effective plan types; optimize existing wellness programs and on-site clinics; and improve member/employee satisfaction and retention. To learn more, visit www.changehealthcare.com.
As we bid farewell to 2013 and resolve to make the New Year a healthier one, I’m reminded of the importance of education and information in keeping our bodies and our healthcare budgets strong.
It’s a new benefits year for many and, for plan sponsors, a new opportunity to teach members or employees the basics of health insurance and about the extreme price variance that exists in the marketplace. Equally important is arming them with the tools they need to comparison shop for medical, dental, vision and pharmacy services – weighing quality AND cost so that they (and you) might maximize the value of their healthcare dollar.
Why invest in such efforts?
They support the shift toward more cost-effective health plan types, such as defined-contribution and high-deductible health plans. According to Aon Hewitt’s 2013 Health Care Survey, while only 10 percent of employers offer CDHPs as their only plan option, another 44 percent are thinking about doing just that in the next three to five years.
They drive member/employee engagement and loyalty. In fact, employees who rated their benefits education highly were more than twice as likely to agree that their employers care about their well-being as those who found their benefits education lacking. In addition, some 79% of these say they would choose to stay with their current employer even if they were offered the same pay and benefits elsewhere. (UNUM, 2012).
They encourage population health. According to Robert Wood Johnson Foundation, the more engaged patients are, the more likely they are to obtain preventive care, such as health screenings and immunizations, and to adopt healthy behaviors, such as monitoring conditions and following treatment, asking questions of providers, and using quality information to select a provider.
They help control your benefits cost growth trend. Plan members who used our cost transparency tools and made purchasing decisions based on value saved approximately $500 per year per person on a claims-verified basis.
It’s a new year and the time is right to educate and empower your members or employees with the information they need to become better healthcare consumers. At Change Healthcare, that’s what we do. I invite you to engage with us today.
This week, Change Healthcare reached another important milestone – we closed on our largest round of financing yet. The round, which was led by HLM Venture Partners, and includes new investor Noro-Moseley Partners, along with existing institutional investors BlueCross BlueShield Venture Partners, Sandbox Industries, Mitsui & Co. Global Investment, Gary and Mary West Health Investment Fund and Solidus, will infuse $15 million into our company. More importantly, it provides market validation of the opportunity and confidence in our ability to improve how Americans purchase healthcare in this country.
In recent months, there’s been a dramatic increase in our nation’s focus on healthcare cost transparency – driven largely by the federal government’s release of medical billing data earlier this year and, of course, the much-talked-about Time magazine article “Bitter Pill”. With this increased focus has come a broader understanding of what Change Healthcare has long known: Consumers not only need healthcare cost information, but also an education in what it means to be a smart healthcare shopper…how to understand basic concepts, like deductible, co-pay and health savings account…how to become engaged healthcare consumers…and how to maximize the value of their healthcare dollar. With each day that passes, we are reminded that Change Healthcare is bringing important solutions to some pretty big problems at just the right time.
For this new funding, we are tremendously grateful. Grateful for the confidence and support of our investors, both old and new. Grateful for the opportunity to continue growing and nurturing a company we believe in so deeply. Grateful to be better positioned to help consumers take control of their healthcare.
With this new funding, we will accomplish much. We will expand our sales and marketing efforts, and accelerate product development. We will bring providers more fully into the cost-transparency conversation. And, we will maintain our position as the market leader in healthcare consumer engagement.
The U.S. Senate Committee on Finance recently held a hearing to discuss the role of price transparency in curbing America’s healthcare cost crisis, recognizing Change Healthcare as an innovator in tackling the important issue. Those who spoke at the session included Steven Brill, author of the much-discussed Time magazine cover story that exposed shocking “sticker prices” hospitals and healthcare systems charge patients.
In his statement to the committee, Chairman Max Baucus (D-Mont.) noted that Change Healthcare offers price transparency tools that can zero in on meaningful pricing information: “These tools can help Americans be smarter consumers. They can help employers and plans form better partnerships with providers that can help keep costs down.” Sen. Baucus hit the nail on the head in this straightforward statement – above all else, we must proactively engage consumers to make more educated decisions about their care and, ultimately, lower costs.
The importance of price transparency in healthcare becomes even more important when you consider the growing popularity of consumer-directed health plans (CDHPs). According to a recent report by the American Association of Preferred Provider Organizations (AAPPO), CDHPs were the only type of health insurance plan that grew in 2012. An estimated 39 million people were enrolled in CDHPs in 2012, up from 33 million in 2011. This percentage will likely continue to grow as companies prepare for the implementation of the Affordable Care Act.
The proliferation of CDHPs and imminent shift toward health insurance exchanges is also increasing the use of health savings accounts (HSAs) – another reason to make cost transparency a priority. According to America’s Health Insurance Plans, enrollment in HSAs has reached nearly 15.5 million, growing by almost 15 percent since last year. HSAs place large sums of money in the hands of consumers and rely on them to spend it wisely. How are they to do this without access to complete, accurate cost information?
Price transparency is the first step to changing our healthcare system. Not only do we need to make personalized cost and quality information available to consumers, we also need to educate them on how to use it, and engage them in meaningful ways to make the best healthcare decisions for themselves and their families.
A recent New York Times article titled “The $2.7 Trillion Medical Bill” compares the costs of common medical procedures – like colonoscopies, hip replacements and angiograms – in the U.S. and other developed countries. The article’s findings are shocking, but not surprising. Increasingly we’re hearing about the extreme differences in healthcare costs between our country and others like Spain, Switzerland, France and Canada.
But what about the price variances that exist within the borders of our own country? Within our own cities…our own zip codes…even within a single provider network. Case in point, Change Healthcare’s client data shows the following price ranges for healthcare services for employees in the same geographic area on the same benefit plan:
- Diagnostic screening colonoscopy: $786-$1,819
- Type II Diabetes Screen: $51-$437
- CT Scan: $375-$3,035
“The $2.7 Trillion Medical Bill” (and data like these) reinforces the importance of cost transparency and consumerism in healthcare…the importance of individuals comparison-shopping for care with an eye for quality AND cost.
Of equal importance, the article reinforces the need for better consumer education on the basics of healthcare. Ms. Yapalater, who shares with readers the story of her routine $6,385 colonoscopy, says she has insurance, yet can’t figure out why she has to pay so much. The fact is words like these are uttered far too often – and when people don’t understand things like deductibles and coinsurance, the consumer experience can be surprising and upsetting. It’s a big part of why greater cost transparency without an understanding of the business of healthcare won’t necessarily improve the consumer experience or financial outcomes.
At Change Healthcare, we’re committed to ensuring consumers have the tools and knowledge they need to become engaged, savvy healthcare shoppers. See how we can help educate your employees or plan members as part of a holistic approach to consumer engagement at http://www.changehealthcare.com/product/healthcareuniversity.html.
Young families are having an increasingly difficult time staying on budget in this tough economy, where each unexpected expense can cause an uneasy shuffling of priorities – especially when it comes to healthcare. One recent survey from the National Foundation for Credit Counseling found that 64 percent of Americans couldn’t handle a $1,000 emergency. To show how the average American is handling such costs, Anna Mathews’ personal finance column in Sunday’s edition of the Wall Street Journal showed us how TaKeisha Woodson, a credit analyst, saved nearly 50% on a prescription simply by taking advantage of change:healthcare’s Ways to Save Alerts™. But there is much more to TaKeisha’s story.
First Horizon National Corporation is a self-insured employer that offers the change:healthcare cost-comparison tool to its employees. TaKeisha is married to a school teacher, has two young children, and just like most growing families, she must juggle the challenges of making smart purchasing decisions with the need for quality care. In addition to the savings referenced in the WSJ, in May of this year her ten-month-old son became sick and was prescribed antibiotics by his pediatrician. TaKeisha arrived at the pharmacy to pick up her son’s prescription and was shocked to see a $100 price tag for a basic antibiotic. Instead of simply accepting the price at the pharmacy, TaKeisha knew she had options. Once she returned home, she logged onto her computer and using the change:healthcare Cost Lookup™ tool, found the same medication at nearly half the cost at another nearby pharmacy. In addition, with the change:healthcare cost comparison tool, TaKeisha will continue to receive proactive e-mail alerts on her routine prescriptions and doctor visits, letting her know how she and her family can save money in the future.
Her story is a testament to the power of actionable cost transparency – and it is just one of many. Through access to pricing information and a proactive outreach strategy that helps consumers take advantage of savings opportunities, TaKeisha is one of thousands of employees who are able to maximize the value from their healthcare benefit.
It definitely makes you wonder how much our healthcare system could save if everyone had access to the same tools as TaKeisha. Stay tuned for more savings stories from patients and employees …
With the passage of the Affordable Care Act in 2010 and the monumental changes likely to occur in how healthcare is purchased, delivered and reimbursed, it only felt natural for me to make a change in my career.
I’ve spent the past eight years in the pharmacy benefit management industry with CVS Caremark, so I was fortunate to work with a broad cross-section of health plans and large self-insured employers who were all interested in better managing healthcare costs.
While some focused on reducing pharmacy utilization to curb costs, others took a more holistic approach by seeking to drive better adherence and higher rates of gap-in-care closure as their way to ‘bend the trend.’ Although I may have chosen pharmacy, this same debate exists in many other areas of the healthcare universe, whether you look at diagnostic imaging services, wellness programs, or disease management. Essentially, you’re either focused on the near-term or you’re focused on the future.
Regardless of the approach, there is a general lack of understanding among employees about what their care actually costs. I constantly heard from HR benefit managers, “Our employees don’t understand that their $30 co-pay is not the entire cost of the prescription!” or, “If our employees only knew what prescriptions cost us, they might make a different and less expensive choice.”
For me, this is how change:healthcare is changing the game. Not only are they making personalized, plan-specific, cost-and-quality information available to the employees, they are also highlighting savings opportunities to make them understandable and actionable.
As I started to think about this in the context of healthcare reform and what some have referred to as the “retailization” of healthcare, I was drawn to the proactive, personalized approach change:healthcare is taking.
By 2014, healthcare exchanges will likely be a reality, and the individual market will likely be a more meaningful segment of the healthcare marketplace. Whether you believe the McKinsey survey that predicts 30 percent of employers will drop coverage or the Mercer survey (PDF) that indicates only 8 percent will drop, the individual market only will continue to grow and a greater number of individuals accustomed to having their benefits chosen for them will now shop and pay for those benefits themselves.
With this change comes the need for education, information and tools to assist those individuals with how best to spend their hard-earned dollars on healthcare. As employees continue to bear a greater portion of healthcare costs each year and with the market clamoring for this information today, we are in a great position to help fill a major gap in the healthcare system.
If my first month at change:healthcare is any indication of the marketplace’s demand for healthcare cost transparency, I can’t wait to see what the future holds. And with that, all I can say is get ready – it’s going to be an exciting ride.