Harvard Pilgrim Health Care has moved deeper into the business of transforming health care into a commodity governed by the rules of the marketplace. Plan members can get cash rewards'yes, like those you get for buying ink at Staples---if they use facilities for outpatient medical procedures and diagnostic testing recommended by the health plan, not their doctors. Harvard Pilgrim wants to steer patients to cheaper providers, hoping to save money for the company and ultimately the patient who will pay lower insurance premiums. With the cost of a MRI of the spine ranging from $492 to $2083 in Massachusetts, you can see why the health plan might want to step in and save money by influencing patient choices.
If Harvard Pilgrim members choose the SaveOn program, they will simply call the plan's clinical concierge service, which will direct them to providers who will charge less for mammograms, colonoscopies, MRIs, and other scans and tests. If they go to one of the recommended low-cost providers, Harvard Pilgrim will send them a check, which the plan's CEO hopes 'becomes a conversation at the watering hole when members say hey I just got a check for $75. Rebates range from $10 to $75 depending on the service and the amount of the savings. Presumably patients would get more cash for obtaining an MRI from a cheaper provider than they would for a thyroid-function test.
Hmmm going against doctor's orders in a land where we implicitly trust our doctors to steer us to other providers they in turn trust? How do you know if the cheaper provider gives good or bad service? Do they read a scan as well as the doc recommended by your own physician?' Is a rather small rebate worth the risk of going to someone you know little or nothing about? I called officials at Harvard Pilgrim seeking answers.
The program, now available to some 5000 Harvard Pilgrim customers, is voluntary, and the plan doesn't know how many have signed up yet because it's too new. Will it become mandatory? Rick Weisblatt, the health plan's senior VP, didn't think so, although he did say that the 'transparency approach---putting information out there isn't enough. Something more like cash rebates are necessary to change medical behavior on the part of patients.
Then we got to the core issue'how do you know the cheaper providers are better? Weisblatt explained that Harvard Pilgrim relies on some of the usual indicators like accreditation, credentialing, malpractice history, loss of license, and measures that tell how well a doctor is caring for diabetic patients or if patients have had timely mammograms. But how do you measure a radiologist's ability to interpret a scan. I pressed. 'This information doesn't exist, Weisblatt admitted. 'For specialists there are not a lot of good quality measures. There hasn't been as much push for that (kind) of measurement. He did say that's changing.
But until that happens, what's a patient to do?' I rang up Dr. David Himmelstein, a Harvard Pilgrim member, single-payer advocate, and a professor of public health at City University of New York. When his Massachusetts doctor gave him a choice of providers for a CT scan---either the one he recommended or a cheaper one suggested by the health plan---Himmelstein took his doctor's recommendation explaining that he chose 'medical advantage over the cost advantage. It's not just an image, it's a professional relationship, he said. 'We know there's huge variability in reading mammograms. Interpreting an X-ray is a subtle thing. You want to go to people who are good.
How do programs like SaveOn square with the drive for more coordinated care? "We say we want coordinated care and at the same time insurers are saying 'go somewhere else," Himmelstein says. The real issue here is who's in charge of medical care'the doctor who believes he's coordinating a patients' needs by sending them to a radiologist he trusts or the insurance company, which believes it doesn't matter who performs a service that seems like an interchangeable commodity as long as it costs less?
So far, patients still determine the answer.