By MATTHEW HOLT
They may have started with a Blues plan in a small state (Hawaii) and been moving deceptively slowly for a while, but having got Optum (part of United Healthgroup) on board last year, today American Well announced the landing of the other big Kahuna. Wellpoint will be rolling out American Well’s online care program in “certain markets” in Q4 this year.
If California isn’t one of those markets, expect some bitching and whining from at least one Wellpoint member in San Francisco! More seriously, as I’ve been saying for a while, Wellpoint’s online services for its members are a mess, and I’m looking forward to what the integration with online care looks like from the user end.
More from American Well to come, as I’ll be popping by their session at AHIP this morning (yes, it’s a slow recovery from last night in Vegas).
Full Disclosure: American Well is a corporate supporter of both THCB and Health 2.0.
Categories: Uncategorized
“The downside of using claims data is that to generate accurate estimates you need to look back quite a while”
Exactly, lacking large enough data set is a huge problem and one reason we needed to partner with the PPOs, we have business in most states but not significant data in any one. If we only relied on our data it would be meaningless. The problem we are left with is not all PPOs support this concept, many are just shakedown partners for providers. If they won’t let us audit a certian hospital’s bills I am certain they aren’t going to let us push data telling people not to go there in the first place.
Looks like we’re basically going in the same direction. One reason to use historical claims over fee schedules is that you also collect data on practice patterns. A sophisticated algorithm will bundle claims usually seen together for treatment of a condition (actually seen together, not just hypothesized according to best practice theory). Likewise, if provider A tends to upcode while provider B does not, you could capture that in the algorithm to generate the cost estimate. I like this feature a lot.
The downside of using claims data is that to generate accurate estimates you need to look back quite a while…typically more than a year to get a sufficient number of data points, especially if you are doing a provider-by-provider estimate. If some of the data is two years old, it probably isn’t the same fee schedule as something being paid today. More sophistication in the algorithm is needed to account for that, or just let the data be what it is and provide caveats to users.
“If a doc has unused capacity in Duluth that would go to waste, instead someone hours away in Grand Portage could go for a visit without leaving home.”
This is a very interesting point and the effect it could have on rural healthcare. A doctor could set up shop in small town america, have affordable housing and excellant quality of life and still treat the patient base in the big dirty cities. Not all visits can be remote but a good number of doctors have a better life to look forward to.
We use maybe 30 different PPOs so it ranges all over the place. The bigger PPOs are fee schedules, some of the hospital owned PPOs are different.
Interesting article on Castlight, surprised their webnsite is so scarce, they don’t appear ready to sell it widely. The one we are starting to work with also uses EOB, actually historical claims data not the argerous task of culling individual EOBs. I believe the reason they do it is to collect provider charges and actual final cost. It is easier to collect provider pricing and final payment from one source then going out to every single provider. In theory a PPO has all the data and would be the best place to find the final cost of the medical bill. What these websites do is present this data in usable formats.
My plan now, which usually proves wrong and changes 100 times, is to design the plan with an additional deductible, if the member checks the website and chooses one of the cost edffectibe providers that deductible will be waived. I think it will only work with financial rewards/penalities.
I really love the concept though, I think it has a better chance then most recent ideas to lower cost without negative impacts, or potential negative impacts blown way out of proportion by people with no understanding of healthcare insurance and delivery
Thanks for the guide i found it really helpful.
Nate, are you using individual provider fee schedules, or something else? Big article in the NY Times on Castlight Health and price transparency. They apparently are using EOBs (not sure how they collect them), though presumably you wouldn’t have to resort to that.
We’re also going in this direction. My take based on early data: for now, people will use this than they do PHRs, but not by that much, and it depends on the amount of cost-sharing in the product. Also, in keeping with my previous post: if your website doesn’t have much of interest on it other than claims review and doc search, you won’t have the critical mass of traffic needed to make a tool like this highly successful.
American Well is interesting. I met some of those folks at the World Healthcare Congress a couple months back, and they definitely have a slick and appealing presentation. The future will without any doubt involve a lot of tele-health, but we’re still very early on the adoption curve.
I don’t think the pieces are in place for this to be a substantial chunk of the market for 5 years, and even then I think it will take a decade before this really settles in as normal and common. Video capability is the main barrier for potential users, aside from inertia. Don’t forget: senior citizens may be online now, but not with cutting edge equipment. They lag the rest of the population by some years, and video cameras are only now becoming common on laptops. Quality video is another matter still.
I know American Well isn’t just about video, but to my mind that’s their main competitive advantage over Relay Health, etc. I’m happy for someone to correct me, even a company rep.
Oh, and a big driver for web visits will be the drop in primary care availability, driven primarily by preferential payment for specialist care, and exacerbated by the increase in the insured through health care reform. We will need to use the capacity in the system as efficiently as possible, and the web helps us do that. If a doc has unused capacity in Duluth that would go to waste, instead someone hours away in Grand Portage could go for a visit without leaving home. Obviously, a lot of things can’t be done remotely, it’s better to have continuous rather than fragmented care, etc., but next generation tele-health certainly will have a role to play eventually.
As Nate and Vikram note, there is no reason to think that a payer just putting this up on the website and issuing a press release will result in a significant number of people using it. The lesson of Kaiser is that you need a critical mass of things on the website before it is a go-to destination: appt. scheduling, e-visits, claims/encounters, Rx, Labs, PHR, decision support (preventive health reminders), Health Risk Assessment, etc. Here the whole is more than the sum of the parts.
I don’t see that as much of a threat. If Suburb hospital came to me and demanded the same reimbursement as cleveland clinic I would tell them to pound sand. In communities where you don’t have provider competition I could see that as a problem and there are other ways to deal with that. Providers compete for business, historically it was newess of facilities and latest technology, we need to make that competition on price
By transparency issues I was referring to fact that provider with lower contracted fees will demand higher fees. That’s been the argument against displaying provider fees information publicly.
great question, human nature, but what part I have no idea. Its the same part that leads people to over pay for Rx when the pharmacy down the street gives it away for free or take brand when generic is available. I think it all comes back to not being their money, so far I haven’t seen any transparency where the patient really suffers for their decision.
Nate- I believe you are showing prices for the benefit of your HDHP members. It’s interesting as we had heard about price transparency causing problems. Wonder why wouldn’t your subscribers use it.
the website shows PPO doctors/Hospitals within a set number of miles who perform a service. It shows the range of PPO reimbursement then links to outside quality measures and also has feedback from other members.
It targets provider of rqual quality with price difference, if the hospital across town does the same thing just as well 30% less why not go there?
It’s distracting from this topic but I couldn’t exactly figure out Nate’s methodology of finding most efficient provider. Are folks looking for most efficient or best provider? It’s interesting because I had a colleague walk up to me and asked help to find him best doctor since I keep ranting about this topic. So we went through few steps but it was tedious and I wonder how many actually look out for best doctors.
it would be interesting to get Matt’s dream list, offer it to him then see if he would even sign up….
we are rolling out a new tool that allows members to see the PPO discounted range of proces for services to hopefully pick the most efficient provider. In discussing it the major carriers have considered it a failure becuase members aren’t using it. While they get bashed for not doing more what they have done has next to zero ROI.
I’m hoping ours performs much better and we can get some adaption, only way to find out is to try it. If it doesn’t work I should send the bill to Matt and all the other 2.0 fanatics and bashers that claim we don’t do enough.
American Well is interesting, hoping to get some more info on them and see how the cost compares to Tele Med. Tele Med has been another disappointment, usage just isn’t anywhere near what we had hoped. So far lost money on it but it looks good on the sales material.
That’s nice but will they come to Wellpoint’s website? It’s a vicious circle. They don’t place great deal of information because no one comes except to check for unpaid claim. Clients don’t come because claims mostly get paid out. Then Matt says they are claims processors, nothing more. Maybe, it will be nice if Matt could lay out his wishlist in entirety.
” Wellpoint’s online services for its members are a mess,”
If you have the time to expand upon this I would love to hear what you don’t like and what you wish was available.