Health Insurers' Online Tools Give Consumers Purchasing Clout

9 Health IT Tools Patients Should Understand

Imagine being able to go online and comparison-shop for surgical procedures, lab and radiology tests, and physician office visits. If you're one of 14 million United Healthcare (UHC) customers, you can do just that with myHealthcare Cost Estimator at www.myuhc.com.

UHC recently unveiled the online service, designed to help consumers locate quality care and estimate the cost of more than 100 common treatments and procedures. "We have always had a cost estimation tool, but we have enhanced that tool for consumers to get a simple online shopping experience for healthcare by putting the right information around different care paths," Nick Martin, vice president of innovation research and development for United Healthcare told InformationWeek Healthcare.

"We have enhanced it to offer a more accurate development tool for them, whereby we actually bump it up against a contracted fee schedule for those physicians and hospitals," said Martin. myHealthcare Cost Estimator provides estimates based on available fee schedules and actual contracted rates with care providers. If that information isn't available, estimates are based on previous claims with the care provider.

Here's how the tool works: A physician recommends, for example, that a patient get an MRI. The patient uses the tool to search for a MRI testing facility close to his or her home, analyze data about the quality of the facility, and learn about the costs associated with an MRI. Equipped with that information, "[The patient] can make a relevant decision about where to get that MRI done," Martin said.

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Here are some of the key features offered by myHealthcare Cost Estimator:

--Cost estimates for more than 47 geographic areas, covering more than 100 different treatments and procedures

--Tools to compare quality and cost information for 240,000 different physicians and hospitals

--Estimates tailored to a participant's specific benefits plan identifying out-of-pocket and employer-paid costs, and real-time account balances in eligible health care accounts that can be applied to expenses

--The ability to assemble cost estimates by matching physicians with the specific facilities where they practice

--Common alternate treatment options to educate patients on their choices

--Information about how benefits work and how costs are determined

By the end of this year, UHC will offer the myHealthcare Cost Estimator in its Health4Me mobile platform for iPhones and Android smartphones. "The prevalence of mobile technology is in a dramatic growth spurt right now. We recognize that and want to meet that need for the consumer," Martin said.

Surgery or the Treadmill? In a similar initiative, Aetna's Welvie Surgery Decision Support Program (accessed through through Aetna's Navigator secure member website) lets its members consider whether surgery is the best course of treatment or if they can consider other alternatives. For example, the program can help a member who's considering knee or hip replacement choose from a series of scope procedures or a course of physical therapy as a way to mitigate pain.

"The goal of the program is not to discourage members from getting surgery, but [to] educate them on the options that are out there," Paul Marchetti, head of National Care Management for Aetna, told InformationWeek Healthcare. According to the CDC, Marchetti explained, 77% of surgeries are elective and in many cases consumers aren't aware of the alternatives to surgery.

The Welvie Surgery Decision Support Program provides information related to 60 medical procedures, including lower back surgery, C-section delivery, and tonsillectomy. In 2011, Aetna had 800,000 members enrolled in its Welvie pilot program, which included five large national employers. It's since been rolled out to include 13 million members who can access the program through their computers, smartphones, or iPads.

The multi-step program helps members work with their doctors to determine treatment options, pinpoint the right diagnosis, and if surgery is required, decide on a facility and anesthesiologist. It also helps educate members on how to prepare for surgery and what do to after discharge.

An Aetna member satisfaction survey revealed high satisfaction rates for Welvie. For example, 96% of its members were satisfied with how Welvie prepared them for surgery; 95% said they are likely to take the steps necessary to prepare for surgery as a result of the Welvie program, and 92% said that are likely to recommend the Welvie program to family and friends. In addition, 93% indicated that they feel that Welvie helped prepare them to speak with their health care provider about surgical options.

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