A Colorado health system is rolling out an online price estimating tool that enables patients to comparison shop some medical procedures.
That in itself isn’t new—systems such as El Camino Hospital, a 443-bed hospital based in Mountain View, California, have put in place price-estimator tools that allow patients to see the estimated out-of-pocket costs for about 80 procedures. They can also see which carriers cover those procedures.
But what makes the new price-comparison tool now offered to patients by UCHealth—a network of 10 hospitals covering Denver and the northern and southern portions of Colorado—unique is the level of detail patients can research medical prices and their out-of-pocket expenses. The tool provides individualized price estimates that are specific to a patient’s own insurance coverage and allows the patient to access the data though the health system’s online patient portal, a mobile app and through a dedicated call center.
Accurate estimates have been difficult for hospitals to provide because a patient’s out-of-pocket responsibility depends on their insurance plan details, as well as how much of their deductible and out-of-pocket maximum they have reached, information only the insurance company and patient have, says UCHealth president and CEO Elizabeth Concordia. For example, a patient with a $5,000 high-deductible insurance plan would have a dramatically different responsibility than a patient with a low deductible or someone who had already reached their out-of-pocket maximum, she says.
With its price-estimator tool, UCHealth says it is now able to immediately connect with an insurance plan, confirm a patient’s insurance information and even identify how much of their deductible and out-of-pocket maximum the patient has already met during their plan year. The patient then can select from multiple UCHealth locations and services to compare costs and receive an estimate. Services include MRIs, CT scans, deliveries, orthopedic surgeries, cataract removal and more, the health system says. “This service helps patients understand and plan for their out-of-pocket expenses for healthcare,” Concordia says.
Estimates for more than 150 services are available now, and more will be added. Patients can access the tool through UCHealth’s My Health Connection portal, an app or by calling a customer service agent.
It took UCHealth about a year to develop the tool with some support from Epic Systems Corp., its electronic medical records system vendor. The price-estimator tool was initially launched in October and since then the tool has been “in soft launch,” says a health system spokesman.
So far, the tool is being used by patients for “hundreds” of quotes per week, the health system says. Today, five UCHealth hospitals, including University of Colorado Hospital in Denver, are live on the tool with five other hospitals expected to be connected next year. Plans also are in the works to add more urgent and emergency care procedures to the price-comparison database.
UCHealth information technology specialists used the system’s electronic medical records system and pulled detailed information from the health system’s master contracts with “hundreds of insurance plans” to build the database for the price-estimator tools. UCHealth programmers also worked with additional information from insurance-eligibility systems and with individual plans to build the portion of the database that gives patients their individual information such as deductibles and year-to-date out-of-pocket costs. “It was a challenge in pulling together all of the information,” the spokesman says.
The price-estimator tool is integrated with the My Health Connection portal and gives patients the capability to schedule an appointment and perform other self-service tasks after they are done comparison shopping. In the future, patients also will be able to compare prices on physician fees for the about 800 doctors that are directly employed by UCHealth.
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