Finding affordable healthcare services is a challenge for the majority of Americans. Deductibles and out-of-pocket costs continue to increase, and many individuals simply cannot afford a health plan. Consumers are now looking to shop for their needed medical services based on value, which includes both quality and cost. Consumer choice and price transparency create incentives at all levels and motivate the entire system to provide better care for less money.
Bundled Cash Pricing
A relatively new concept of posting bundled cash prices online for procedures and imaging has taken the healthcare system by storm. This trend in the healthcare transparency movement towards providing a fair and reasonable price that is publicly posted is significantly changing how consumers view and purchase healthcare. Time magazine, Business Insider and other national publications have featured stories on these types of providers. More and more providers are willing to quote a bundled cash price over the phone to patients who ask. Employers are also starting to incorporate this type of pricing model into their health plan by incentivizing participants with lowering or eliminating out-of-pocket costs.
Direct Primary Care & Telemedicine
Two new options—direct primary care (DPC) and telemedicine—in the primary care space are changing the way consumers interact with primary care.
DPC* physicians do not take insurance or third-party payments, but instead charge a low, monthly fee to patients. This covers all or most primary care services, including clinical, laboratory, consultative services, care coordination and comprehensive care management. DPC physicians work only for the patient and generally offer same-day or next-day appointments; the ability to text, video chat and email the physician; urgent care services; and often medications at wholesale prices. Some employers are also adding DPC as a benefit of their health plan to incentivize wellness and value-based healthcare purchasing decisions.
Telemedicine is another new option that gives patients the option to have an “appointment” with a physician via telephone or video conference for minor health services. Telemedicine is low cost, convenient and efficient for the diagnosis and treatment of minor conditions.
Online Shopping Tools
Individuals can leverage the benefits of technology by accessing online shopping tools to evaluate and compare prices for medical services. The Free Market Medical Association (www.fmma.org) offers an online search tool that allows patients to search by type of provider, procedure name or even by CPT code. PriceMDs (www.pricemds.com) allows users to search and book appointments with doctors, dentists, hospitals and surgery centers worldwide. Medibid (www.medibid.com) is an online tool that allows providers to competitively ‘bid’ on performing medical services. Healthcare Bluebook (www.healthcarebluebook.com) offers a public site for users to search for medical procedures or services, and results provide a fair market price for that zip code. Patients can use that information to compare or negotiate pricing at their local facilities.
Transparency in the Medical Marketplace
Remember, high-quality healthcare does not need to come at a high price. In the costly world of healthcare, higher prices are not a good indicator of quality due to how services are reimbursed by third-party insurance companies and Medicare. Lower prices in healthcare often represent a provider’s ability to compete based on efficiency and positive outcomes.
Healthcare services can and should be viewed just like any other purchase—based on value, which includes both quality and price. Fortunately, the time of cost and quality being hidden from consumers is over. The information is now available to those who seek it!
*Consult a qualified tax advisor before becoming a DPC patient if enrolled in a Qualified High Deductible Health Plan with an HSA.
This article was contributed by Advantage Health Plans Trust (advantagehealthplans.com).
This information is provided with the understanding that the association is not engaged in rendering specific legal, accounting or other professional services. If specific expert assistance is required, the services of a professional should be sought. Provided as a public service by the Pennsylvania Association of Community Bankers.
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