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No more Let’s Make A Deal-style pricing in health care

Kaiser Health News recently reported on a study from Health Affairs that found a majority of consumers do not associate price with quality when it comes to health care.

This could be interpreted as great news.

On the one hand, Americans appear to be hearing the message loud and clear that health care pricing can be irrational. This has no doubt been proven out through personal experiences.

On the other hand, as the article points out, pricing in the rest of our economy serves as a proxy for quality. There’s a reason the rusted used car costs a lot less than the brand new SUV. Likewise, cars with similar features tend to hover around similar price points. In health care, it’s not that easy.

Costs for the same procedure can vary widely, even among health systems and clinics within a stone’s throw of one another.

Without price as a quality indicator, a trip to the doctor’s office can feel a bit like the old Let’s Make A Deal TV show, with Monty Hall asking, “Do you want to keep your illness, or take what’s behind Door Number Three?!?”

The intrigue of the TV show, of course, is that you never know what’s behind that door. However, in real life, this is a terrifying prospect – particularly when you are exposed to increased out-of-pocket costs if the door you choose doesn’t provide a good value.

But what if you knew what you were getting behind that door? It sure would make it easier to decide whether you wanted to keep the $50 or take the new dining room set, wouldn’t it?

Those of us in the risk management business think so too, and that’s why you’re seeing health insurers working with forward-thinking health care systems to align our efforts around cost and quality. The goal is to not only improve health care, but also make it easier for consumers to spot high-quality health care systems based on the alliances and programs in which they are engaged.

You may have seen such endeavors discussed by an alphabet soup of acronyms, including ACO (Accountable Care Organization) or PCMH (Patient-Centered Medical Home). All are great steps toward a more affordable, accountable and understandable health care system, but we think more needs to be done.

The latest way Anthem Blue Cross and Blue Shield is working to simplify health care is by creating a 50-50 joint venture health insurance company with Aurora Health Care, known as the Wisconsin Collaborative Insurance Company. The new company will offer an insurance product for Wisconsin employers later this year, called Well Priority, which is designed to deliver a lower overall cost of care, healthier consumers and higher patient satisfaction.

Well Priority features some of Wisconsin’s highest-performing health care systems, including UW Health, ThedaCare and ProHealth Care, and will be available in 45 counties where more than three-quarters of the state’s population resides. Additionally, when traveling or outside the state of Wisconsin, Well Priority members will have access to national and international coverage through the Blue Cross and Blue Shield Blue Card network.

We created this company to produce health-focused health care. Believe it or not, much of our health care today is actually “sick care.” It sits passively by until urgent action and medical interventions are needed.

Well Priority products seek to turn this around by combining Aurora’s best-in-class care delivery system with Anthem’s insurance expertise to create a new and better way of delivering health care to consumers.

The professionals of Aurora and Anthem will be working hand-in-hand to identify gaps in care, provide a personalized experience, and keep consumers healthy by keeping them actively engaged in their health. By sharing data, a missed prescription refill is more likely to be noticed, and reminders for key screenings – such as colonoscopies – can be tracked to make sure potential health problems are caught early on.

In short, our goal with Well Priority is to keep people healthy and actively engaged in their care to help them live well. We do not expect Well Priority to change health care overnight, but we do expect it to help Wisconsin employers starting this year.

Think of it as our way of giving you a peek at what’s behind Door Number Three.

Just for fun: YouTube celeb The Numberphile runs down your mathematical odds of correctly picking the right door on Let’s Make a Deal. Applied to health care, the odds are not in the consumer’s favor.

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Nobile is a 20-year veteran of the insurance industry whose experience includes time with Rush Prudential Health Plans, Aetna, and United Healthcare. Prior to joining Anthem, Nobile served as the Director of Sales and Account Management for the Midwest region at UniCare, a health benefits company based in Chicago and owned by Anthem’s parent company and also ran UniCare’s Eastern Region with offices.

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