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Insurers Pay Patients To Opt For Cheaper Tests

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Health insurers are upping the ante when it comes to pushing their policyholders toward cheaper imaging.

We’ve mentioned a couple of instances, last year and earlier this year, of insurers trying to persuade patients who had been referred for advanced imaging to switch to a cheaper imaging provider. Now some insurers are paying patients up to $200 to try a less-expensive alternative.

Some members of Anthem Blue Cross and Blue Shield in New Hampshire, Connecticut, and Indiana can receive $50 to $200 if they get a diagnostic test or elective procedure somewhere that charges less than the facility their doctor recommended. Michelle Andrews of Kaiser Health News detailed the offers in an article published Monday.

Denise McDonough, regional vice president of sales for Anthem Blue Cross and Blue Shield of New Hampshire, explained the program this way:

We identified a subset of highly utilized services with cost variances that we thought would have a big impact. We want to provide information to members to drive health-care costs down.

The “highly utilized services” covered by the Compass SmartShopper programĀ  include bone imaging, heart imaging (SPECT), CT scans, mammograms, MRI, and nonmaternity ultrasounds.

After a doctor recommends a covered procedure or test, a policyholder can call Compass SmartShopper for information on less-expensive locations in the policyholder’s area. The policyholder can request that the doctor change the service to a less-expensive location.

Afterward, following payment of the claim, the policyholder gets a cash reward in the mail. The policyholder also has the option of sticking with the original, more-expensive location. There’s no penalty for that, but no cash bonus either.

Insurers concede that the system looks purely at economic factors without regard to quality of care. That worries physicians’ groups. “We have concerns about giving economic incentives without giving weight and credence to quality measure,” Scott Colby, executive vice president of the New Hampshire Medical Society, told Kaiser Health News.

On that purely economic basis, the initiative does seem to be working. The city of Manchester, New Hampshire, which became the first employer to try the Compass SmartShopper pilot program in January 2010, has saved more than $250,000 in health-care costs in two years, even after deducting for the cash bonuses to the 476 members who have participated.

Expect such experiments to spread. Their overall impact will depend on many factors, not least of which is the outcome of the current Supreme Court assessment of the Patient Protection and Affordable Care Act.

Related seminar: Cardiac Imaging


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