Compass Chief Medical Officer Eric Bricker discussed Why You Should Think Twice Before Using Your Insurance Carrier to Find a Doctor during the April 2018 Compass Navigating Healthcare Webinar.
Finding a physician is the first and most important step in helping employees and their families improve their health. And yet most people don’t do background research before selecting a doctor. Instead, they stumble upon them, asking a friend or family member, going to an insurance carrier website or just going to the place they drive by on their way home from work.
If you find a doctor this way, it’s like throwing dice. You may have a positive outcome, or you may:
- Receive more (or less care) than you need
- Find a doctor who doesn’t know what he’s doing
- Pay too much for care
The irony is that some employers don’t think, “If my employees did a better job of selecting doctors, it would be better for their health and better for the financial sustainability of our plan.”
Roadblocks to Better Care Recommendations
There are four roadblocks to making better physician choices:
- Incomplete information
- Biased information
- Non-personalized information
- Untimely information
Roadblock No. 1: Incomplete Information
Think about when you are comparing two physicians on an insurance carrier website. The listings include their name, whether they’re in-network, their photo, the price of an office visit, their relative proximity and some type of star rating. However, it’s usually unclear where that star rating comes from.
What you can’t determine from a carrier website is the practice patterns of these physicians. For example, do they refer patients to expensive imaging facilities, prescribe brand-name medications, perform surgeries at expensive facilities, etc.?
At Compass, we use a proprietary database of 6.3 billion price points across more than 13,000 procedures and data from more than 250,000 individual provider interviews each year to study the practice patterns of every provider we recommend. As a result, our analysis can show which providers:
- Tend to lead with less invasive care over surgery
- Have a tendency to refer to less expensive imaging or lab facilities
- Tend to do procedures at less expensive facilities
- Have on-site specialty care (i.e., a diabetes educator, nutritionist or dietitian)
- Have same-day or next-day appointment availability
The lack of complete information on carrier portals results in employees not making the best provider choices. In the example above, many patients might choose Dr. Smith because his office visit costs $15 more than Dr. Garcia. However, Compass data shows that Dr. Smith’s overall episode of care costs are thousands of dollars more expensive than that of Dr. Garcia. To have a better healthcare navigation experience, you first need better data.
Roadblock No. 2: Biased Information
Insurance carriers have their hands tied when it comes to providing unbiased physician recommendations because they serve multiple masters, including: patients, contracted providers, themselves – and employers.
One of the values insurance carriers provide is the size of their networks. In other words, the bigger the network, the better. However, by having a bigger network, the carrier has less leverage when it comes to negotiating with doctors and hospitals.
For example, the hospital-carrier contract might prohibit the carrier from steering patients away from the hospital’s birthing center. There are also rules in the contract that says the carrier can’t share specific cost information with members, employers or clients.
A lot of carriers say they’re trying to change this, but the important word is “trying.” If the hospital system has enough leverage, it will make sure this language is in the contract. Or the hospital will only allow the carrier to share the price range – not the specific price – for procedures to be posted on carrier sites. These price ranges tend to be very broad and might say a procedure could cost between $400 and $4,000.
By contrast, ambulatory surgery centers, independent imaging centers and smaller independent hospitals don’t have this type of leverage. So, a carrier can tell them it wants a 50 percent discount, and it’s going to get $550 for an MRI, and the carrier will post the price on its website.
Roadblock No. 3: Non-personalized Information
People don’t start out as healthcare consumers, they start out as people who are in pain and need help. Listening to employees and anticipating their needs are essential to establishing trust.
It’s important for employees to get healthcare information from a trusted source. This is where insurance carriers have difficulty. According to recent studies, insurance carriers are the second least trusted industry in America – just behind the tobacco industry.
In fact, a Harris Poll reported that only 7 percent of Americans trust their health insurance carrier. So, even if the insurance carriers have the most accurate information, people have a hard time believing it.
Roadblock No. 4: Untimely Information
At the end of the day, if people get the right information at the wrong time, it’s completely useless. This is where outreach based on claims is a real problem. By the time the claim is incurred, submitted, adjudicated and sent to the case manager, it could take three or four months. By this time, if the insurance carrier calls the patient, the patient will say they’re calling two months too late. This again hurts the insurance carrier’s credibility.
Employees need help at certain points of time. It might be when they’re picking a health plan during Open Enrollment, or comparing procedure costs before a major surgery, or needing help with a confusing bill or understanding how their benefits work. Or maybe they’ve moved, need a second opinion, or are shocked when they go to the pharmacy and find their prescription costs are through the roof.
It’s important to use the member’s pain in navigating healthcare as the triggers to provide education and help employees make smarter healthcare decisions.
Selecting a Doctor – Making the Right Choice
People are typically not effective in choosing a physician they like on their own. A recent study shows that when people select a primary care physician on their own, they typically give them a Net Promoter Score of +3 on a scale from -100 to +100. (Net Promoter Score, in this context, measures the likelihood of patients to recommend the doctor to a friend, colleague or family member.)
In contrast, when people use a healthcare navigation vendor like Compass to help them find a doctor, they give the doctor a Net Promoter Score of +77.
Employees are equally happy with the subspecialty providers Compass recommends, giving them the following Net Promoter Scores:
- Neurosurgery = +93
- Oncology = +93
- Orthopedic surgery = +82
- Pediatrics = +82
- Ophthalmology = +84
- Cardiology = +87
- OB-GYN = +88
- Dentists = +89
Helping employees find highly rated, cost-effective providers, understand their health benefits, guide them to the right programs at the right time and drive lower prescription costs is what Compass is all about.
To learn more about healthcare navigation, please visit WhyHealthcareNavigation.com.