Finding a physician is the first and most important step in helping employees and their families improve their health. Yet, most people stumble upon their doctors, 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.
Today’s lookback blog is a recap of the April 2018 Compass Navigating Healthcare Webinar entitled Why You Should Think Twice Before Using Your Insurance Carrier to Find a Doctor.
If you don’t do your research to select a doctor, 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.