Column 61 What are insurers doing about Health Care Costs and Access to Care?

What are insurer's doing about Health Care Costs and Access to Care?

*What are the insurer's doing about access to urgent care or clients that don't want to wait to see a doctor?  Anthem has provided a new benefit: LiveHealth Online to small group and individual members as well as some large groups.  Even non-members can use the service for $49 copay. You can check it out at LiveHealthOnline. Com. Any time after enrolling, members can select a provider from the group of available doctors online at the time they wish to have a LiveHealth Online visit. Next, they submit their symptoms and soon begin a live video conversation with their selected physician. LiveHealth Online maintains an electronic record of every visit, and members can forward this information to their primary care doctor as needed.

Clearly this is not the same as going to see your primary care doctor who knows you and your history.  But it give you a convenient option to see consultation.  I tried the service to get a sense of the doctor's response. I was pleasantly surprised at the questions asked and the in-depth questioning that he presented to me before he gave me a course of action. 


On  August 5, 2014, the California Integrated Data Exchange (Cal INDEX), a new not-for-profit organization, announced plans to develop a statewide, next-generation health information exchange (HIE) - a comprehensive collection of electronic patient records that will include clinical data from healthcare providers and health insurers. The result will be one of the largest exchanges of its kind, initially providing physicians and nurses with secure, online access to approximately nine million health information records - or nearly one-fourth of the state's population. Cal INDEX expects to be operational by the end of 2014.

According to the insurer's, Cal INDEX was created to address California's fragmented and complex healthcare system. The inability to share valuable health data can result in incomplete information, affecting everyone in the healthcare system - individuals, providers, employers, and producers - and can lead to poor-quality patient care and waste and inefficiency.

Our Rotary Club had a presentation today regarding pharmaceutical drug addiction and I can see where this data base might make it easier for a physician, hospital or pharmacy to recognize those that go to multiple doctors or emergency rooms in hopes of getting extra pain killers.

Blue Shield of California (Blue Shield) and Anthem Blue Cross co-founded Cal INDEX and will provide funding for its first three years of operation. After three years, participating providers and insurers will pay subscription fees. Not all of the plan from each carrier will participate initially.


A recent study shows that given price transparency consumers will respond.  The study was followed 61,000 members and when they were given a phone call advising them of the priced difference for different vendors in their area and they consistently chose the more cost effective vendor, saving about $95 per test.  Those that did not receive the information tended to use the MRI that cost about $125 more, a $220 spread.

 The article about this study quoted an article in the Annals for Internal Medicine concluded: " Price variation in health care services has been at the forefront of health care discussions for several years. For example, price variation for imaging scans is widely documented with at least one study showing that MRI scans can vary in price from $300 to $3,000 with no demonstrated difference in quality."

When we look at health insurance premiums 85% of the premium must be paid in direct medical costs under the ACA (Affordable Care Act).  If we want to control premiums, we need to control the driver which is direct health care costs.  The industry is slowly finding ways to provide more transparency.  In the meantime, it makes perfect sense for consumers to ask about the costs of a procedure, test or Rx before they choose.


With more high deductible plans being chosen, these cost differences effect the consumer directly.  When researching a colonoscopy claim for a client, I was quite surprised to find that under Anthem two local vendors had allowed amount pricing that differed by several hundred dollars. I never did get a satisfactory explanation from Anthem as to the difference.