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How Rewards Nudge Members to Shop for Care

Helping people find value when they choose medical treatments and providers may be part of the solution to the rising costs of health care and insurance.

Price shopping may be especially helpful for people whose health insurance plans have high deductibles and other forms of cost-sharing. But health care prices are often hard to find — and even harder to understand.

Many efforts to bring health care prices into the light are underway. The federal government, for example, recently started making hospitals post their charges online.

But unlocking the power of consumerism in health care will take more than putting numbers on a website.

People generally say shopping for care is important, but not many take advantage of price-comparison tools when they’re available, according to a 2017 survey.

“That’s the $64 million question: Why don’t consumers use the price-comparison resources that they say they want?” said Leanne Metcalfe, Ph.D., who leads consumer research for the Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas.

“One thing is clear,” Metcalfe added. “Using price-comparison tools to find cost-effective providers can have a significant impact on health care spending once more people start using them.”

This was confirmed in a new study published in the journal Health Affairs

To motivate members to be informed consumers, the Blues Plans offer their large group customers a program that gives eligible members $25 to $500 if they choose from a list of cost-effective providers. 

The program, called Member Rewards, led to 2.1% reduction in average prices paid for eligible services in the first 12 months, according to the study.

To qualify for rewards, members can shop for providers online with the Provider Finder tool or — if included in their plan — by calling a Benefits Value Advisor. The amount of the reward varies by the provider and the cost of the service.

Prices for elective procedures often vary widely within the same communities.

The rewards program had the biggest effect on costs for certain imaging tests, according to the study. When members shopped, prices were 78% less for ultrasounds, 33% less for mammograms and 25% less for MRIs.

The researchers looked at one year of claims for about 270,000 employees and family members covered by 29 self-insured employers participating in the program.

Overall, the employers paid out $204,000 in rewards for the year. The reduction in prices indicates they saved $2.3 million, translating to about $8 per employee, according to the study.  

The authors noted that engagement in rewards program was modest. “Health plans and employers that more successfully engaged enrollees might find more robust savings,” they wrote.

More than 180 million Americans get health insurance at work, and large employers cover about 70% of their workers’ total annual health care costs.

As a result, employers are constantly looking for ways to reduce these costs and make sure employees are getting quality, cost-effective care in return for their investment.

One alternative to the Member Rewards approach is reference-based pricing. In this model, a member who chooses a high-cost provider for certain procedures pays the difference between the actual price and the reference price. Another strategy is guiding members to providers recognized as “centers of excellence” for care such as transplants and joint replacements.

“Employers we’ve talked to see a lot of upside benefit to rewards programs,” Metcalfe said. “They realize their greatest challenge is getting employees to shop for care like they do for shoes or cars or other household items and services.” 

 


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