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Transparency Matters: Gaining Insight into Medical Quality and Costs

Imagine going into your favorite grocery store to do your weekly shopping, but there are no prices on any of the products. At checkout, the cashier says, “Don’t worry about paying. We’ll send you a bill.” Several weeks later, you’re shocked to get a bill for thousands of dollars more than you expected.

You wouldn’t stand for not knowing the prices of your groceries, clothes, gas or other items before you buy them. So why do we accept not knowing how much medical procedures cost before we have them?

Having insight, or transparency, into the quality and cost of medical care can be empowering. You might be amazed by how much costs for the same medical service can vary, locally and nationally.

In New York City, the cost of a knee MRI ranges from $179 to $4,945, while the costs for the same procedure in Miami range from $142 to $4,406. If you pay a 20 percent coinsurance, your costs could be anywhere from $29 to $989, so it pays to comparison shop for care.

The need for transparency becomes even clearer when facing high-cost procedures like a lumbar fusion. Costs range from $5,520 to $95,955 in Miami and from $26,004 to $265,908 in San Francisco. A 20 percent coinsurance payment for a lumbar fusion in San Francisco can range from $5,201 to $83,182.

What’s more, a study by Families U.S.A. concluded that higher-priced care providers do not necessarily deliver higher-quality care or better health outcomes.

Infographic: Cost of health care services around the U.S.

 

Would your decisions on where to receive care change if you had the opportunity to see quality and cost information beforehand?

Recent studies have shown that medical cost transparency resources for consumers may help people save money and select health care professionals based on objective information. On an individual level, consumers who compared costs using a mobile or online resource paid 36 percent less for their health care services than those who didn’t use the service.1 The analysis also found people who use online or mobile transparency resources are more likely to select health care providers rated on quality and cost-efficiency across all specialties, including for primary care (7 percent more likely) and orthopedics (9 percent more likely).

Nationwide, the use of medical transparency resources could reduce health care spending by more than $100 billion over the next 10 years, according to a report by the Gary and Mary West Health Policy Center.

“UnitedHealthcare has been investing in quality and cost transparency resources for more than 10 years, helping our members and all Americans comparison shop for health care as they would other consumer products and services,” said Craig Hankins, vice president of digital products for UnitedHealthcare.

 

The following resources can help provide cost estimates, and in some cases provide estimates based on actual contracted rates with physicians and hospitals.

Available to all: UnitedHealthcare’s quality and cost estimator at uhc.com/transparency

This online resource aims to help all consumers access health care cost information. People can review market average rates in their local areas for more than 800 common medical services, including in-patient and out-patient procedures. The site also provides a comprehensive view of what to expect throughout the course of treatment for various medical services, helping people review the typical steps involved with their potential care.

Available to all: Nonprofit Health Care Cost Institute’s (HCCI) transparency tool at guroo.com 

The data powering this resource is drawn from billions of claims provided by the nation’s leading health insurance companies, representing more than 50 million Americans. People can learn about conditions, including the likely steps of care and the likely costs for each step; compare costs across different locations to identify areas where services may be most affordable; and review common questions to ask a health care provider to better understand choices and treatment options.

For UnitedHealthcare members: Health4Me®, a mobile app, and myuhc.com, a member website

This mobile app and online resource gives UnitedHealthcare plan participants access to information about health care quality and costs. Users can comparison shop for health care services based on quality and cost, with estimates based on actual contracted rates; access personal health plan details, including a digital ID card, as well as deductible and copay information; locate a network physician, hospital or medical facility; and pay medical bills by credit card, debit card, health savings account or bank account transfer.

“People are starting to take action: nearly one third of Americans have used the internet or mobile apps during the last year to comparison shop for health care, up from 14 percent in 2012, according to a recent UnitedHealthcare survey,” Hankins said. “As we work to help make health care more efficient and enable people to more easily navigate the health system, online and mobile transparency resources have the potential to help improve health outcomes and make care more affordable.”

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1. UnitedHealthcare analysis of claims data, 2016