Purchaser Insights: A PBGH Blog

In American health care, we continue to see aggressive adoption of new technologies that don’t fulfil their promise.  We continue to wonder who’s minding the store – who is evaluating these technologies, assessing their “value” and their risks, and designing coverage and benefit programs to encourage the use of effective treatments and discourage the use of questionable ones.  Today’s news is about failed hip implants:

http://www.nytimes.com/2011/12/28/business/the-high-cost-of-failing-artificial-hips.html?_r=1&ref=health;

last summer it was angioplasty:  http://online.wsj.com/article/SB10001424052702304760604576428323005864648.html?mod=googlenews_wsj

and spine surgery:  http://www.npr.org/blogs/health/2011/08/24/139923555/hospitals-have-got-your-back-maybe-a-little-too-quickly.

Why don’t we think about the Exchanges as a place for people to choose their health care, not just their health insurance? Read more....

On September 25th,  I presented at the Annual Health 2.0 2011 conference in San Francisco as part of the “Employers 2.0” panel.  The panel discussed the integration of online health and wellness programs and applications into health benefits, new developments in worksite clinics, and how Health 2.0 tools are helping employees purchase care in a different way. 

I challenged employers to think of the new age of consumerism as an opportunity to lead the way in improving access and quality while controlling costs , which engendered lively discussion between employers and business innovators in this space.  Throughout the discussion, I emphasized the following:

Employers are searching for ways to get their employees more educated about the pricing of real procedures so they can make informed decisions and be active participants in reducing their health care costs.  Cost calculator tools are real-time, pre-care itemized estimators of specific treatment costs, designed to be used by employees or plan members to:

•       Find a provider;

•       Understand the amount s/he will be expected to pay;

•       Make an informed decision to choose a lower-cost, potentially higher-quality provider for the care they need.

Health plans are offering their own tools through their member portals, but there are some interesting tools being offered by third-party vendors, from start-ups to established health data analytics companies.

Recently, PBGH held a series of webinars to both educate its members and help them evaluate some of the leading tools on the market.

Here are some questions employers can ask themselves when considering such tools:

·         What is the data source for the price estimates? For example, there are advantages and disadvantages to claims versus contracted rates?

·         Is the information that is presented to the employee specific to their plan and benefits design? 

·         Which providers, treatments, conditions, and facilities are included in the tool?

·         How can I effectively plan and build enhancements and reporting with either the health plan or the third party vendors providing the tool?

·         How does the tool support customized benefits design approaches, such as reference pricing or global health budgets with incentives for employees to save on health care costs?

PBGH will be offering an evaluation of these tools and a set of best practices to support members in answering the questions above.  To learn more, please contact Amanda Goltz, Senior Manager, at 415-615-6356 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Writing for the Health Affairs blog, PBGH CEO David Lansky argues that for ACOs to truly deliver better care at a better cost, participating providers must improve their performance

James Caillouette, MD, Surgeon in Chief, Hoag Orthopedic Institute, shares his insights on building an Orthopedic Value-Based Center of Excellence.