Insurers changing payment models
July 14, 2014
At DocSpot, our mission is to connect people with the right health care by helping them navigate publicly available information. We believe the first step of that mission is to help connect people with an appropriate medical provider, and we look forward to helping people navigate other aspects of their care as the opportunities arise. We are just at the start of that mission, so we hope you will come back often to see how things are developing.
An underlying philosophy of our work is that right care means different things to different people. We also recognize that doctors are multidimensional people. So, instead of trying to determine which doctors are "better" than others, we offer a variety of filter options that individuals can apply to more quickly discover providers that fit their needs.
July 14, 2014
Health insurance companies have tried a variety of different payment models, but the predominant model continues to be fee-for-service, where physicians get paid more for doing more. Recently, there has been more talk about insurers paying for value, not just for the volume of procedures done. A survey cited by The New York Times estimates that 20% of reimbursements are tied to care improvement and reduced costs. That sounds remarkably high given the lackluster uptake of pay-for-performance (P4P) even just five years ago. This could be a welcomed trend for the discriminating consumer of health care services.
Questions to watch as this trend unfolds:
1) Will physicians encounter situations where there is a conflict of interest? (e.g. maybe skipping a test that might be useful in order to qualify for a value payment)
2) Will physician engagement be better than the P4P schemes of the last decade?
3) Will patients notice the difference?
4) Will these care quality assessments be made public so that patients can choose accordingly?
July 04, 2014
For years, CMS has encouraged physicians to submit information about their practice via a program called PQRS. On its Physician Compare website, CMS would list whether physicians have enrolled in its pay-for-reporting program, but the actual numbers that were reported would not be disclosed publicly. People have speculated that it would only be a matter of time before CMS decides to publish the actual metrics, and CMS recently proposed doing just that in 2016. We look forward to this additional step towards greater physician practice transparency.
Happy Fourth of July!
June 28, 2014
There's been an increasing drumbeat for the disclosure of health care prices. The Washingon Post published an article that discusses the failure of a state legislature to create an all-payer claims database that would help consumers compare health care prices. The main opponent? The state's largest private insurer, Premera. An earlier article noted "a broad coalition" that included big businesses such as Boeing.
What was Premera's response? Executives were reported to have indicated that they "favor transparency" but doubt "the usefulness of the all-payer claims database if it's not coupled with information about what consumers would actually pay under their insurance plans... 'We have not seen evidence they're ready for that level of shopping.'" Premera executives are essentially saying that they can't possibly imagine how this data could be useful, and that consumers can't handle this level of sophisticated shopping. Their words underestimate consumers. Much more likely, though, the executives floated those lines so they wouldn't have to address the real reason behind their reluctance to support transparency for the larger population (which the article discusses).
May 25, 2014
Later this week, we plan on releasing an update to our user interface. It's been a while since we've changed the basic color palette of this site, and we've been feeling that the look-and-feel has started to feel dated. Our complete user interface overhaul won't be finished this week, but will likely continue over the next few weeks.
If you have any thoughts about the changes, please let us know.
May 17, 2014
Health Care Cost Institute announced that they will be working with three major insurance companies to make health care prices available to consumers, starting in 2015. On the face of it, this announcement has tremendous importance for the health care transparency movement, and would have been hard to imagine even a few years ago. If this portal actually comes to pass, it would be a very exciting moment. We need to wait to see, however, how much information is actually disclosed, and whether the portal will end up as useful as we might imagine.
The move seems to make a lot of sense for the insurers. By arming their members with additional cost and quality information, members can make better decisions, hopefully saving both the members and insurers more money in the process. To take things a step further, insurers could make this information freely available in a standardized format so that smaller scale innovators can build on top of this data, potentially in more engaging ways.