As price transparency in health care takes many different directions, most of the focus remains on transparency of medical procedure costs.  One company, Brighter.com, is adding insights and the ability to price shop for dental care, and often-overlooked category of medical services.  Brighter.com is available in 47 states and has a subscription business model.  In return for a $79 annual fee, you get a discount of up to 60% on dental care.  Users can also browse dental rack rates for free.  The New York Times recently wrote about Brighter.com.  We will follow this concept closely as it evolves.

Tags: dental price shopping | dental price transparency | brighter.com

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If you are in the maket to participate in High Risk Insurance Pools, you may have just gotten a price break.  The WSJ HealthBlog carried a story yesterday on how usage of the pools is far below what was originally forecasted, and the federal government will decrease the premium cost in states where they control the program.  23 states' programs are run by the Dept of HSS, while some states control the operation of their own high risk pools.  This map will tell you what the situation is in your locale.

The high risk pools are intended to provide health insurance for the chronically ill -- those with preexisting conditions that limit their access to regular insurance plans.  In 2014, Health Reform laws will mandate that the insurance companies can no longer turn people away for preexisting conditions, so the risk pools are intended to be a temporary patch for those who can't wait until 2014 for coverage.

Tags: high risk insurance poools | ppaca | health reform | department of health and human serv | preexisting condition | chronic condition insurance

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We've written about the trend for discounted generics at many of the nationwide pharmacy chains, and the emergence of the $4 prescription.  This customer-friendly development has done a small part to improve the transparency of healthcare costs, and undoubtedly saved consumers thousands of dollars.  But consumers shouldn't forget about asking their pharmacists to price match.  Dr. Leslie Ramirez of Leslie's List, a Chicago-based blog that has nationwide relevance, gave some excellent tips on finding price matching deals at pharmacy chains.  While the article focuses on some familiar Chicago names, many of the chains have a nationwide presence.

More here:  http://www.leslieslist.org/community/viewtopic.php?f=6&t=241

Tags: $4 drugs | discount drugs | price matching | pharmacy

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For those with Medicare Part D coverage, 2011 is a new year  on a few fronts.  The infamous coverage gap, also known as the donut hole, begins the first year of a decade-long phase out due to the health reform law.  As with many things related to health reform, the law will change gradually with a few early benefits for Medicare enrollees. Those affected by the Part D donut hole should begin to see the benefits as soon as they spend their 2,840th dollar on medication.

As Jim Miller Points out in a recent article, there are a few things seniors can do to minimize the cost of their Medicare Part D coverage.  The first is to be aware of the donut hole discounts, which apply to drugs purchased when the enrolle has spent between $2,840 and $4,550 on medications for the year.  The discount is 50% on brand name and 7% on generic drugs, and does not affect one's progress toward the top end of the donut hole range.  The second tactic is to do something that even those without Medicare Part D can do, shop around for drug prices, including buying in bulk, mail order, or splitting pills when it is safe.  The third is to be aware of some of the assistance programs available for those making less than about $16,000 a year.

Medicare Part D enrollees will need to follow the changes annually, as all of dollar tiers and discounts mentioned above will change until 2020, when the donut hole will be phased out entirely (assuming health reform is implemented as scheduled).

Tags: 2011 part d discounts | medicare prescription drug plan | medicare part d coverage | medicare donut hole | medicare part d

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In January, Walecia Konrad of the New York Times ran an excellent Q&A piece providing a doctor's perspective on the consumer driven health movement.  The interview with Dr. Jeffrey Kullgren of U Penn Medical Center provides a valuable glimpse into how a physician sees the patient-doctor relationship when it comes to having price discussions.  Granted, Dr. Kullgren is an authority on consumer driven healthcare and likely more in tune with this issue than most physicians, but the physician angle is one that we don't hear enough of when it comes to this topic.

The Q&A is very tactical, with Kullgren giving excellent tips on initiating and guiding these discussions with your doctor.  Among other points, he notes that patients should recognize they are not the only ones who may feel ill-prepared to discuss costs with their doctors -- physicians have long been trained to focus on treatment and not cost.  As a patient, being prepared to direct the conversation in a useful direction may be necessary.  Also, be assertive when it comes to things such as having tests or diagnostics done per your doctor's request.  Pricing shopping for that test rather than simply going to the specialist your doctor suggests could end up saving you signficant money.

A great read, and we hope to print more from Dr. Kullgren in the future.

Tags: physician | price transparency | consumer driven health | health care prices

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Two articles in the mainstream media caught our eye this week.  As the healthcare industry focuses on things like Information Technology and using up the ARRA funds, there is still a building buzz around the need for consumer price transparency.  The first article is from the Houston Chronicle, interviewing Michael McCallister, the CEO of Humana.  McCallister talks about the virtues of transparency both in the pricing and quality of medical services, something we couldn't agree with more.

The second article is from the esteemed New England Journal of Medicine, and focuses on medical cost transparency.  It argues that several governmental initiatives to create price transparency have either negative or unproven results, and the only real way to get to healthcare price transparency is by knowing what the patient portion is and comparing that across providers.  It also interestingly discusses a scenario where improved price transparency could actually raise some prices, based on the Most Favored Nation status of some insurance contracts.  An interesting read.

Both articles show that the movement of price transparency and consumer driven health is still on the minds of leaders in the industry, even if it has been temporarily muted by HIT and health reform.

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The HIMSS conference, an annual health technology gathering that attracts more than 30,000 attendees and about 1,000 exhibiting companies, concluded yesterday.  The buzz was, as expected, where the big money is -- things like hospital and clinic electronic medical records (EMRs), interoperability between various systems, and the continued phrenetic energy around eletronic record implementation associated with the original stimulus bill, ARRA. 

The extent of true patient-facing, price transparency tools was limited to a few select niches.  The concept of patient check-in kiosks is becoming popular, with everyone from larger companies like NCR and Merge healthcare to a bunch of smaller companies offering the ability to check-in and resolve copays via a kiosk.  The other clear trend was the patient portal concept, where a patient can log in to a portal to communicate with their provider and, if the manufacturer builds it well, perhaps learn about their financial responsibility and make a payment online.  The big (and mind-bogglingly expensive) electronic medical record companies like Epic and NextGen have a good handle on this, as do other players like NextGen and even Microsoft.

Given the conference's focus on the industry insiders rather than consumers, it appeared rather light on direct-to-consumer products in the consumerism arena, but that is to be expected given that the typical attendee of the conference was a health provider IT worker, a software vendor, or a health consultant.  Still, based on what we saw and what we continue to read, we think the health price transparency market still fragments into four main categories: 

- Websites devoted exclusively to healthcare consumerism, like yours truly, HealthHarbor, and others
- Insurance company price portals which are popping up all over the country.  We commend them for doing this, but question the value of having healthcare price information so fragmented, and do people really trust the insurers to provide this information? 
- Companies who offer data and potential services to help individuals or companies with price transparency, such as Compass and Castlight who both have proven models, and others
- Software and analytics focused on helping the physician office be the reliable source of detailed and transparent patient liability information, such as MD Clarity

If nothing else, HIMSS was a testament to the money being thrown at healthcare today.  An excellent account of the conference can be found at one of our favorite blogs, HisTalk, which is aimed mainly at industry folk but an interesting read for anyone.  The writers provided a daily recap of HIMSS, and based on their posts must have walked every inch of the exhibit floor and spent a few hours each night writing.  The best HIMSS recap we've seen yet.

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Iris Kimberg, at the OutOfPocket blog, writes that the past year has introduced several new price shopping tools for doctor prices.  Most are likely based on some variation of Medicare or historical payer rates, as insurance companies and doctors are usually hesitant to fully divulge their contract terms or fee schedules.  Still, it is the step in the right direction for people simply wanting a rough estimate of their health care costs.

Tags: price transparency | health care | price shopping

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We've summarized all of the consumer-facing health reform changes for 2011 in our own summary, but Smart Money did a good job of recapping key tax-specific changes that consumers can expect in 2011.  Among others, changes in FSA and HSA limits, as well as increased visiblity of health care costs on W2s.

Tags: health reform | tax | health care | 2011

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The Wall Street Journal writes that Moody's has measured a noticeable shift in consumers' healthcare spending habits with the recession.  Among other changes, Moody's noticed that people are spending less on expensive medical procedures and not as readily having medical services that are not covered by their employers or insurance.

Seeing a reduction in healthcare spending isn't in itself a bad thing (unless you are a doctor or a hospital in today's reimbursement environment), and if patients are the ones choosing to self-ration, it takes away the "big brother" or "death panel" claim that someone else is preventing one from getting the care they need.  Hopefully, however, it doesn't equate to a decrease in preventative care, which would likely be a penny-wise, pound-foolish trend.

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Welcome to the new HealthHarbor blog!

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