Consumerism and Reference Pricing August 19, 2016 Sarah Durfee, RN, Clinical Programs Officer, OPERS Veronica Hawkins, VP, Statewide Accounts, Medical Mutual
Reference Pricing A Value Based Insurance Design strategy that caps payment for a particular medical service --- member pays the difference between the cap and the provider’s contracted rate. OPERS’ Goals:
• • • •
Encourage consumerism with regard to health care services Engage members in care seeking decisions - affect member behavior change Introduce pricing transparency/concept of price variation Preserve choice and access. Financial savings was not a primary objective
Strategy • • • • • •
Focus groups to understand literacy of plan participants 12 month educational campaign System capabilities/electronic engagement tool preparedness Network analysis Provider contract renegotiations
Communication messages
Lessons Learned • Health literacy: don’t assume fundamentals of insurance are understood; health care is complex
• Cannot over-communicate: personalized, relevant, impact • Providers willing to conform in advance of effective date: consider contract effective dates, changing landscape
• Don’t underestimate member/provider relationship: equip members with talking points
Audience Poll #1 How comfortable are you asking your doctor about the cost of services he/she orders for you? Not at all comfortable
Moderately comfortable
Extremely comfortable
Audience Poll #2 What would you expect to be the difference in cost for a MRI of lower extremity in the Midwest? < $100
$100-$500
>$500
Lessons Learned • Providers are not aware of (other provider) health care costs • Cost difference needs to be more than $10-$20 to affect member care seeking behavior --- convenience trumps cost
• Access: ensure reference price does not inhibit access to a preferred provider or establish standard exception processes
• Keep ultimate goal in mind: establish benchmark reporting to validate future effort
Questions?