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Translucence, II

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An interview with the director of Aetna's price transparency program.

Last week, we began to explore the exciting new world of “transparency” in regard to health care. Briefly, transparency means that the cost of various services, including any network discounts, are known in advance of receiving said service(s).

The actual implementation of this principle is still in its infancy, but some carriers have begun to make the information available to their insureds. One of the pioneers in this effort is Aetna. Last fall, I had the opportunity to interview the man responsible, Dr Dexter Campinha-Bacote.

Dr Campinha-Bacote told me that the new program is an integral part of Consumer Driven Health Care  (CDHC). Several of Aetna’s major clients expressed their concern that, as more and more of their employees opted for high deductible plans (HDHP), vital information was lacking. These employers asked Aetna to develop tools that their employees could use to make “better informed decisions.” Aetna lists the 25 most common services for each physician (provider) and the negotiated reimbursement rate for each service. This way, the patient (insured) knows ahead of time what a given service will cost. By accessing the Aetna website (or by calling the company directly), insureds can search by procedure, or provider, or both.

A unique feature of this plan is that one needn’t be on a High Deductible plan (HDHP) to access the information. That’s especially helpful to folks who are covered by a more traditional plan, but subject to a deductible or co-insurance.

I also asked Dr Campinha-Bacote if Aetna was concerned that providers, knowing what their competitors are charging, would seek more aggressive increases in their own negotiated rates. The answer is that a given provider has an opportunity to discuss his own value in the transaction: “why I’m worth more than Dr Smith.” After all, you get what you pay for. So it’s not just about price, after all.

Another concern is that consumers would “shop price,” looking only (or primarily) for the lowest price on procedures without regard to provider credentialing or success rates. Dr Campinha-Bacote assured me that all of his company’s providers are Board certified, and that Aetna conducts frequent member surveys to determine the level of satisfaction each provider enjoys. Of course, the company isn’t responsible for the decisions that its members ultimately make.

Next week, we’ll conclude our interview with Dr Campinha-Bacote, and look at another, quite different model.

Be well.

Henry Stern, LUTCF is an independent insurance agent in Dayton, OH. A licensed Continuing Education instructor for Ohio and Kentucky, he has well over 20 years of experience in “the biz.”  He blogs every day (or so it seems) at InsureBlog.

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from InsureBlog on Sun, 07/23/2006 - 7:48am

This week's column, at The Medical Blog Network, includes an interview with the director of Aetna' price transparency program.



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