Health Care “Blue Book” to Reduce In-network Variance (7% to 14%Savings on In-Network Claims )

        -Expose the degree in-network price variance that exists

        -Disclose that poor quality providers are part of the network

•Members and /or CSR’s enter the diagnosis on-line and are shown the expected cost for each component provider  i.e.(hospital, surgeon, anesthesiologist, etc). 

•In-network cost variance can be as high as 500% for the same services

•Carriers have performed poorly w.r.t providing members with meaningful cost and quality data. True transparency would:

•Side-by-side provider cost rankings (green , yellow , orange, red) are shown by provider name  along with contact information thereby allowing the participant to value shop immediately.

•Employer’s provider quality metrics can be added in

•Via plan design, members can be incentivized to use the “green” providers thereby minimizing the in-network variance to the plan overall.

• Average claims savings is 7% to 14% with proper member incentives.

A simple value proposition: same injury, two very different paths

Lets take a real example from the data.  A parent is playing soccer with their child in the front yard, falls down and injures their knee.  There are two care paths with similar outcomes, but very different costs:

 

Orthopedic visit       $    105          Orthopedic visit       $    105

 

Knee MRI        $  2,500                   Knee MRI        $    507

ACL Surgery        $ 10,000             ACL Surgery        $  2,691

 

Total Cost        $ 12,605                Total Cost   $3,303   
                                                          Lower cost, same or better clinical outcomes