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1/24/2012
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IT Tools Help Patients Cut Prescription, Exam Costs

Change Healthcare provides companies' employees with a Web portal, data analytics, personalized text messages, and email alerts to help them find lower-cost healthcare services and prescription drugs.

It's the start of a new benefits year for most employers, and workers are only beginning to tap into their companies' offering of 2012 healthcare coverage. However, they can expect to face rising healthcare costs and be asked to pay larger co-pays and deductibles than ever if recent years are any indication.

A September 2011 U.S. Government Accountability Office (GAO) report found that from 2006 to 2010, the percentage of covered workers enrolled in high-deductible health plans increased from 4% to 13% and the percentage of covered workers with a deductible of $1,000 or more for single coverage nearly tripled, from 10% to 27%. Meanwhile, overall U.S. healthcare spending has increased by an average of nearly 7% per year, from $1.4 trillion in 2000 to $2.5 trillion in 2009, according to the GAO report.

With the economy ailing, most consumers are looking to stretch a buck, including their share of healthcare spending. Finding price comparisons for care can be helpful. But although there are a variety of federal, state, and private efforts to provide better healthcare-cost transparency to consumers, tracking down this data isn't easy for most consumers, said the GAO.

[ Take control of your health. See 7 Health Education Tools For Patients. ]

Contractual terms between healthcare providers and payers that restrict disclosures of negotiated rates also complicate consumers' ability to find cost information, said the watchdog agency.

Among the small-but-growing set of private companies that are providing healthcare cost information to consumers are payers such as Aetna, which lists cost comparisons on a portal, and technology vendor Change Healthcare, which offers data analytics and Web-based services to employers--and their workers--and health plans.

Change Healthcare aims to ease the hunt for price comparisons by reaching out to individuals with information that's personalized and relevant to them, according to Change Healthcare president Doug Ghertner, who joined the private company six months ago from CVS Caremark.

"There are other look-up tools out there, but with our tool, you don't need to seek out costs," he said. By collecting and running algorithms against claims data, Change Healthcare "looks at what an individual is paying [for healthcare services and products], looks to find where these services and products are available for less, and then reaches out to individuals saying, 'you can save X dollars a year,'" said Ghertner in an interview with InformationWeek Healthcare.

For Change Healthcare clients, workers receive "personalized, timely and relevant" alerts by text or email, allowing them to go onto a portal and check out, for instance, a list of pharmacies in their area where they can refill a maintenance medication, such as allergy or gastric reflux pills, for less than they're paying now, said Ghertner.

Change Healthcare provides information about dental, medical and pharmacy products and services, "helping to maximize health plans once you make your purchase," he said. "We scan claims data monthly, always looking for savings opportunities," he said. That can range from less-expensive pharmacies for prescription medications to less costly medical testing.

"We see tremendous amount of opportunity [for savings] in physical therapy, dental, chiropractory, mental health, and medical imaging," he said.

"A CT scan might cost $538 or $6,000," depending on whether a patient in a particular region goes to a hospital, outpatient facility, in-network, or out-of-network provider for the test, he noted.

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Lisa Henderson
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Lisa Henderson,
User Rank: Apprentice
1/26/2012 | 1:10:13 AM
re: IT Tools Help Patients Cut Prescription, Exam Costs
The Change Healthcare service is really interesting and puts the consumer really at the center of their healthcare choices and decisions. I'm sure that there is a value-add in that the Pinnacle employees are owners in the company and have a stake in the bottom line, but having a service that helps people make choices based on cost, convenience or other factors truly is information that is needed and helpful.

Lisa Henderson, InformationWeek Healthcare, contributing editor
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