Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Patients alone cannot combat high health care prices

Peter Ubel, MD
Policy
September 16, 2020
Share
Tweet
Share

After three months of physical therapy, her doctor told her that it was time to get an MRI. She had already paid off her annual deductible, meaning the imaging test would “only” cost her the $150 co-pay. An imaging center near where she worked charged $1,500 for the test. Just two miles away, another facility would have just charged only $900 for the same test. She arranged to go to the more convenient location knowing the difference in price would be picked up by her insurance company.

Until …!

She found out she was eligible for a rewards program. She called a rewards advice line and found out that if she chose the less expensive imaging center, her insurance company would send her a check for $400. She’d make money on the deal!

I’ve been describing the kind of program that insurers are increasingly turning to in an effort to incentivize patients to be price-sensitive when receiving blood tests, imaging exams, or common procedures. It’s one of the consumer-oriented innovations I explore in Sick to Debt (currently ranked one of the top five books authored by people with the last name Ubel).

In this case, companies liked Vitals Smartshopper are partnering with insurers to reward patients who choose low-cost alternatives. One such partnership involved Healthcare Services Corps (HCSC), an amalgamation of Blue Cross/Blue Shields plans in the Midwest and Southwest. HSCS opened up the rewards program to more than 250,000 people. The rewards covered a wide range of tests and procedures, all of which were offered at a wide range of prices. Here’s a glance at that price variation based on a study published in Health Affairs:

Pretty crazy variation. A fourth of CT scans are less than $264, and a fourth are more than $1,500. Insane.

I’m not privy to exactly what HCSC and Vitals Smartshopper did to advertise the program. I do know that most people who received tests and procedures did not shop around for low-priced providers. Less than 9 percent either called the rewards advice line or logged into the insurer’s price transparency tool. Even with these small numbers, however, the insurer reduced its expenditures by more than $2 million (I have no idea what Vital Smartshopper charged for its work, all of which would have come out of those savings.)

Here is a picture of the average price of eligible procedures before and after the rewards program went into effect, compared to an insured population that didn’t begin the program until 2018.

I like where this program is headed. But I have a few thoughts about how such programs need to evolve.

First, we need to make sure reports from these tests make it into providers’ EHRs regardless of where patients go. It is great to save money on MRIs, but not if the doctors ordering those tests can’t access the images.

Second, such programs should carefully monitor quality of care. I expect that most low-cost providers/testers offer excellent quality. But the rewards program should be designed to weed out low-quality sites, if or when we feel confident we can answer that question. (That’s a whole other tangle of challenges.)

Third, we need to market the heck out of these programs. Instead of 9 percent of people accessing the program, I’d like to see 99 percent doing so. OK, that number is unrealistically high. But even if 1 in 3 patients shopped for prices, I’d expect a quick shift in providers’ pricing strategy, as high-priced sites scramble to keep their customers.

Fourth, I’d like to see more employers demand such programs from insurers. If employers demand smarter insurance, with things like reference pricing and value-based insurance design as well as this rewards program, the health care marketplace will be forced to respond.

It should never be up to patients alone, as “consumers,” to combat high health care prices. Nevertheless, rewards programs like this deserve a role in broader efforts to constrain health care spending.

ADVERTISEMENT

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel, and can be reached on Twitter @PeterUbel. He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. This article originally appeared in Forbes.

Image credit: Shutterstock.com

Prev

Why cultural competency courses should be requisites for medical school [PODCAST]

September 15, 2020 Kevin 1
…
Next

Science and faith in the time of COVID-19

September 16, 2020 Kevin 3
…

Tagged as: Public Health & Policy, Radiology

Post navigation

< Previous Post
Why cultural competency courses should be requisites for medical school [PODCAST]
Next Post >
Science and faith in the time of COVID-19

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Peter Ubel, MD

  • Clinicians shouldn’t be punished for taking care of needy populations

    Peter Ubel, MD
  • Is the FDA too slow to handle the pandemic?

    Peter Ubel, MD
  • Quality measures have gotten ahead of the science of quality measurement

    Peter Ubel, MD

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • To fix health care, ask patients to change their understanding of how a health care system should work

    Richard Young, MD
  • How our health care system traumatizes patients

    Linda Girgis, MD
  • Fixing health care requires putting patients and their health teams on top

    Matthew Hahn, MD
  • Why health care replaced physician care

    Michael Weiss, MD
  • Physicians and patients must work together to improve health care

    Michele Luckenbaugh

More in Policy

  • U.S. health care leadership must prepare for policy-driven change

    Lee Scheinbart, MD
  • How locum tenens work helps physicians and APPs reclaim control

    Brian Sutter
  • Why Medicaid cuts should alarm every doctor

    Ilan Shapiro, MD
  • Why physician voices matter in the fight against anti-LGBTQ+ laws

    BJ Ferguson
  • The silent toll of ICE raids on U.S. patient care

    Carlin Lockwood
  • What Adam Smith would say about America’s for-profit health care

    M. Bennet Broner, PhD
  • Most Popular

  • Past Week

    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • Why sleep is the missing pillar in modern health care

      Carlos Nunez, MD | Conditions
    • Why some doctors age gracefully—and others grow bitter

      Patrick Hudson, MD | Physician
    • How to survive a broken health care system without losing yourself [PODCAST]

      The Podcast by KevinMD | Podcast
    • How the shingles vaccine could help prevent dementia

      Marc Arginteanu, MD | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
  • Recent Posts

    • Why sleep is the missing pillar in modern health care

      Carlos Nunez, MD | Conditions
    • How a family’s strength led to a successful kidney transplant

      C. Nicole Swiner, MD | Conditions
    • The food-drug interaction risks your doctor may be missing

      Frank Jumbe | Meds
    • Beyond the TikTok hype: Rebuilding trust in evidence-based weight loss medicine

      Sarah White, APRN | Conditions
    • The weaponization of rules: How regulatory overreach puts physicians and health care at risk

      Kayvan Haddadan, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • Why sleep is the missing pillar in modern health care

      Carlos Nunez, MD | Conditions
    • Why some doctors age gracefully—and others grow bitter

      Patrick Hudson, MD | Physician
    • How to survive a broken health care system without losing yourself [PODCAST]

      The Podcast by KevinMD | Podcast
    • How the shingles vaccine could help prevent dementia

      Marc Arginteanu, MD | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
  • Recent Posts

    • Why sleep is the missing pillar in modern health care

      Carlos Nunez, MD | Conditions
    • How a family’s strength led to a successful kidney transplant

      C. Nicole Swiner, MD | Conditions
    • The food-drug interaction risks your doctor may be missing

      Frank Jumbe | Meds
    • Beyond the TikTok hype: Rebuilding trust in evidence-based weight loss medicine

      Sarah White, APRN | Conditions
    • The weaponization of rules: How regulatory overreach puts physicians and health care at risk

      Kayvan Haddadan, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Patients alone cannot combat high health care prices
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...