Patient Responsibility News

Health Payer Introduces Price Shopping Tool to Drive Care Quality

A new tool from Blue Cross NC will allow patients to price shop and gain rewards for selecting lower-cost, high-quality care sites.

price shopping

Source: Thinkstock

By Sara Heath

- BlueCross BlueShield of North Carolina (Blue Cross NC) has launched a price shopping tool that allows patients to receive incentives for selecting what the insurer deems lower-cost and higher-quality healthcare services.

Using the new SmartShopper tool, patients can view quality and price information when choosing where to receive certain types of care. If patients choose to receive care from a designated, awards-eligible care site, the patient will receive a cash award of up to $500 mailed via check to the patient’s home.

Blue Cross NC did not offer details about what qualifies a hospital or clinic as an “awards-eligible” care site. However, the payer did suggest that these care sites offer high-quality care for a lesser cost.

This program comes as a part of Blue Cross NC’s efforts to address the growing cost of healthcare in the state of North Carolina and across the country. Healthcare costs and quality remain top-of-mind for 85 percent of all patients, according to a 2018 report from patient advocacy group Consumers for Quality Care.

North Carolina is currently ranked 50th for some cost control measures, Blue Cross NC reported, citing statistics from a 2017 Oliver Wyman analysis.

Recognizing that the cost of a certain healthcare service can differ from clinic to clinic, Blue Cross NC has made a concerted effort to encourage cost-comparison shopping among its beneficiaries. The payer hopes the latest SmartShopper tool will help patients see that there is not always a correlation between cost and quality, said Blue Cross NC chief growth officer John Roos.

“In many industries, a higher price tag often means better quality or value, but many consumers don’t know that this is not the case in health care,” Roos noted in a statement. “Today, we’re the only insurer in the state with a program that offers cash to shop for high-quality care in lower-cost settings. This has an immediate payoff for our customers and lowers their overall health care costs.”

Previously, Blue Cross NC has offered patients access to price transparency tool Blue Connect, which allows patients to view cost estimates for various procedures. While all patients will still have access to Blue Connect, Blue Cross NC will begin rolling out the SmartShopper tool to patients covered by one of the payer’s large employer-sponsored healthcare plans.

Users can “shop” approximately 80 common medical procedures using the cost transparency information provide by Blue Connect and make their price and quality selection using SmartShopper. Once a patient chooses a reward-eligible location and the claim is fully paid, the patient will receive an payment for selecting a reportedly cost-efficient provider.

This program should have twofold financial benefits for patients, Blue Cross NC added. In addition to the reward checks, patients should theoretically see lower medical bills for lower-cost facilities.

This program aligns with what many in the industry are calling for – better price transparency and patient empowerment to select the healthcare services that are best for their care and financial needs. However, critics of the Blue Cross NC SmartShopper program state that the program incentivizes patients to select cheaper, and potentially lower-quality care for a relatively small financial payoff. This could impact long term patient health and healing.

But overall, the healthcare industry has embraced price transparency as a positive step toward patient empowerment and reducing growing healthcare costs. HHS has recently made it a key part of its strategy to reduce drug prices. And most studies agree that patients value price transparency tools, even if those tools are not yet prevalent or are confusing to use.

Going forward, more healthcare organizations are expected to take a similar approach to driving price transparency as Blue Cross NC has. Giving patients the tool necessary to understand the quality of care and the price of their care could help patients make better treatment decisions.


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