Compass has been providing a healthcare price-transparency solution to employers for three years and Castlight Health raised $80 million to try to do what Compass is doing.  Prominent venture capitalists and the Cleveland Clinic gave Castlight Health $80 million for a similar value proposition to Compass.  Castlight’s fundraising further supports the Compass value proposition.  If we were the only people to think of this, then it probably isn’t a good idea.

Compass’ 120+ employer clients in 46 states are actively using Compass to shop for lower cost healthcare services.  Not only are Compass customers saving money, but they also have higher levels of benefit satisfaction and feel very supported during the paradigm shift to a consumer directed health plan.

Here is his last paragraph:

“Before we further remove ourselves as direct consumers of healthcare -with all of our beneficial influence on quality, service, and price – let me ask you to consider one more question. Imagine my father’s hospital had to submit the bill for his “care” not to a government bureaucracy but to my grieving mother. Do you really believe the hospital – forced to face the victim of its poor quality service, forced to collect the bill from the real customer – wouldn’t have figured out how to make its doctors wash their hands?”

This is just one article in a larger number of writings recently that have started to focus on how to accurately calculate / negotiate the true cost of care (thus saving money by comparison shopping and becoming effective healthcare consumers).    Compass is thrilled by the focus on what it believes is the key to controlling healthcare costs.  Unfortunately, some of the messages in these articles are misleading.

The true cost of care is what your insurance has contracted to pay your doctor or hospital.  The hospital pricing tools sponsored by hospitals typically reflect only the charge.  The charge is generally unrelated to the true cost of care which is set by a contract with your insurance company.  Likewise, services such as New Choice Health simply use Medicare cost data and multiply it by some factor to “estimate” what insurance pays.  Insurance contracts (and thus true cost) generally have no relationship to Medicare cost information which makes these estimates very inaccurate.  To accurately anticipate your cost and evaluate healthcare service providers you must have the agreed to price from the insurance contract or fee schedule.

It is this level of market knowledge that Compass brings to the table.  We help our customers get beyond rough cost estimates and use actual fee schedule / contract data to make provider choice decisions.  When you have the Compass level of support and knowledge, you can truly be confident of your ability to assess your market options as a healthcare consumer.

There have been some interesting articles on how vaccination costs have risen to the point where group health insurance compensation is insufficient to support physician administration of vaccinations. In the individual insurance market there are even more complications – most benefit plans limit vaccination and preventive care coverage to $300 per year. This is just one more area where you will need the right expertise to make sure your physician provides critical services and if not, where can you get the best value for your money.

1. Heart Catheterization

2. Labor / Delivery

3. Outpatient Gastro-Intestinal Procedures (Colonoscopies / Endoscopies)

4. Advanced Imaging (MRI / CT Scan)

5. Back Surgeries

While I am not qualified to question or evaluate the validity of the points in the article, the round of questioning by many recognized experts is simply enough to emphasize the need for other ways to control costs.  That is why being in control as a savvy healthcare consumer is so key to both short and long term cost management strategies.

The reason is that outpatient surgical reimbursements often uses an old reimbursement model that pays a relatively high percentage of charges while inpatient reimbursement is often based on a low daily fixed rate called a “per diem”.  The charges do not vary much between settings because most of the charge is driven by the operating room experience and not the overnight stay.  If the charges are both high and nearly the same, a consumer would want to protect themselves against the high charge by choosing the low fixed rate.

At the end of the day, it is up to the doctor whether you qualify for an outpatient surgery.  Even if you do, you might want to have surgery the old fashioned way and stay a night in the hospital.  A little extra nursing care may save you thousands of dollars.  This is a topic you want to be sure is on your doctor discussion list.

The point is that because we were prepared with the right after hour access pediatrician and other care options, we avoided an expensive emergency room visit and survived a mis-diagnosis.  Having additional access to a 24 hour nurseline (which cost $12 to use) allowed us to handle the mis-diagnosis and set us on the correct path to recovery.  All of the medications needed were generic as well. 

1. Take the $4 list from your pharmacy to your physician and ask if you can address your prescription needs with the specific prescriptions on the list

2. Use Compass to coordinate that conversation with your doctor on your behalf

Either way,  be a savvy consumer and don’t let a few pharmacy tricks keep you from paying the true cost of care.