A look at why and how Blue Cross and Blue Shield of North Carolina launched a Web site that lets consumers find the average out-of-pocket cost of many medical procedures. The move was partly instigated by a state transparency law.
The online database was made available to the general public in January. Modern Healthcare says that “It covers 1,200 nonemergency procedures, showing the average total of how much the insurer pays particular providers for an episode of care. The figure is drawn from the insurer’s claims data and includes all costs—the discounted payment, physician fees, facility fees, drug and medical supply costs, as well as consumers’ cost-sharing.”
(But what about many emergency procedures?)
The new service drew criticism from some high-cost providers and some consumer advocates, who said the pricing data weren’t adequately explained.So Blue Cross hopes to improve the tool by “offering additional data on utilization and outcomes patterns for particular providers because price alone doesn’t reveal whether a provider delivers value, ” says Modern Healthcare.
The most interesting part of the tale is that physicians have been among those pushing for more transparency because, as the publication noted, “it would help them as they enter value-based contracts. Internists, for instance, could use the price information to change their referral patterns by looking for high-quality labs or physician specialists offering lower costs.”