Heidi, do you think your doctors could easily adopt how your dentist provides estimates? What other information would help you make better decisions about the quality and cost of your health care?

When I had my daughter, the hospital was able to provide me with an estimate for both a natural delivery and C-section. However, when I had a different surgery the following year I was told no information was available. The fact that they had it for childbirth and collected up front leads me to believe they can get estimates for any procedure but choose not to.

Thanks for sharing your story Bethany. We’ve begun to work on this issue by providing cost estimates through our Find a Doctor search. You can read more about what we’re doing here: http://connect.bcbsnc.com/lets-talk-cost/cost-transparency/

If you are a BCBSNC customer, we invite you to try out Find a Doctor search here: http://www.bcbsnc.com/content/campaigns/mycost/index.htm?cmpid=mycost

What other information would help you make better decisions about your health care?

Thanks Susan, we agree that cost and quality go hand-in-hand. What is the most important way we can work together to lower medical costs while improving quality of care?

I agree there are too many variables to consider to accurately estimate costs up front. One person, for example, may need an additional blood test, x-ray or MRI and the costs could be significantly more.

I am not sure how aware the public is of hospitals being selected for Magnet designation, Chest Pain Center Certified and Stroke Center Certified. Hospitals with these certifications have proven track records of better care. Magnet hospitals generally have more educated nurses (higher levels of BSN, some all BSN and Master prepared nurses). These nurses have more experience, training and are therefore more able to pick up on subtle changes in patient conditions that many times can prevent further complications for patients (which translates into lower costs and lower complication rates). Certification for chest pain and stroke treatment are hard to obtain, meaning a hospital has to meet specific requirements and timelines in order to be certified. One example - a patient having a stroke or chest pain would immediately be assessed and treated rather than having to wait and risk further complications (which means more costs). The emergency room, cardiac cath lab and cardiac operating room are always standing by ready for patients, no delays (no delays by doctors, nurses, etc.). I worked on a hospital committee for Chest Pain Center accreditation and our patients received superior care in the initial treatment of chest pain. Most patients went from ambulance (home) to cath lab with a diagnosis in 30 minutes or less. I would encourage BCBS to look at what it takes for a hospital to be certified, how it has affected the hospitals treatment of patients and if complication rates were lowered. Reward those facilities that do a better job.

Thanks a lot for your suggestion, Susan. BCBSNC is highly focused on rewarding quality heath care, so we appreciate your comments on this front. It sounds like our efforts with Blue Distinction Centers may be similar to what you have outlined. We look forward to hearing any other comments or suggestions.

Thanks for your comment, Michele. You bring up a great point. We agree that quality of care should not be sacrificed to improve cost transparency. The cost estimates we provide are a ball park estimate for many common procedures. Previously, patients have been left in the dark on this information and did not have access to cost data prior to having a procedure or treatment. As you point out, we cannot guarantee the price of a procedure because there are too many variables to consider, including complications. Even so, providing cost estimates is a step in the right direction. We want our customers to have as much information as possible so they can make more informed decisions about their care. How can we work together to provide cost information while improving quality?

Thanks for writing back, Michele. You have hit the nail on the head, and bring up a new payment model we have started to introduce called “flat-fee care” or also known as “bundled payments”. In our flat-fee care model, we work with doctors to determine up-front cost calculations that are developed specifically with the individual patient in mind – taking into consideration the likelihood of complications and other impacting factors. Those cost estimates are not only tailored to the patient, but also encourage collaboration between the various physicians. With this model, research has shown that quality of care actually increases. What do you think about this approach?

To address your other question about the message you hear on our phone line, this is intended to be transparent about our services. Because we can’t predict how a doctor or hospital will submit a claim or code a procedure, we can’t guarantee coverage before a doctor’s visit. This actually goes hand in hand with providing cost estimates, and not being able to guarantee a price due to the variables we’ve discussed. Hope that makes sense. We know it’s complicated.

I'm really not opposed to everything but I am not a fan of flat fees. Call me a sceptic but I get the feeling that BCBS is planning on lower their costs, but I am not hearing anything about how that will affect my insurance rates. Already Docs and hospitals must work together to heal a patient and have the added motivation of being constantly under the litigation microscope- I don't see how see how treating them as a collective society rather than an individual encourages them. I am not a physician but I choose to be paid for my job efforts and not based on a group that I do not control.

As for the BCBS message- I am not asking if BCBS can say how much something will be covered for- I have a deductible which is suseptable to real time changes but I do know that I pay 10%. BCBS has their contracts pay to a portion of the regular billable amount and I realize that I am responsible for the balance- I am saying that BCBS will not even say if a procedure is covered- even with the code.

My experience with needing an antiflammatory and BCBS not ALLOWING my doc to prescribe celebrex so I am stuck with a generic that caused me to to have my feet swell up- now I was told to try another generic and maybe that would work better, if not we will try something else--, I already knew because of samples that the celebrex works with no reaction-- But the price is more (even though I would be paying $35 rather than $10) so I cannot get it-- ***That is what I see as the future of BC/BS new cost cutting measures and it concerns me-- Is BCBS trying to tweek their own budget to lower the premium price-- or just lower the price of approved products, availablity and quality of what they pay for?- It appears that they are saying the docs and hospitals should work together and earn less while BCBS maintains their profit margin.

As BC/BS cuts all of their expenses Do they plan on lowering the prices of their premiums in the future- have they ever?

Michele, we appreciate your taking the time to air your concerns. We welcome everyone’s ideas and opinions, even when they may not be the same as ours. We have roughly 4,000 employees who make decisions about their own health care and their families, so these are questions we have found ourselves asking as well. So I can assure you that we do not want to reduce quality in the name of cost. In fact, we have found in our efforts that when quality increases, costs go down (such as reducing complications or return hospital visits). These are the areas we want to focus on. You bring up a good point about generics, and this is an area we’re seeing reduce spending trends as the cost of branded and specialty medications continue to increase. The use of generics is an important discussion one should have with a physician. But there is evidence that use of generics has helped off-set rising drug costs, so they are an important factor.

As we’ve discussed on Let’s Talk Cost, rate increases are parallel with health care trends and utilization. The goal of our efforts we are putting forth to rein in costs is to ultimately slow the rise in health care spending, which can impact premiums. While this may take some time, I am optimistic that we can make an impact in North Carolina while supporting and improving quality health care for our members. One example I would ask you to consider, this past year we had a rate increase of zero for the Blue Options HSA and Blue Saver plans. I’d say that is encouraging.