Highmark’s Care Cost Estimator Looks Promising

September 19, 2013
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Highmark Health Services, a big Blue Cross Blue Shield plan is rolling out its Care Cost Estimator, a transparency tool designed to get members to make cost-saving choices. The video embedded below does a good job of explaining the tool. In watching it, I’m impressed at just how far these tools have come over the past couple of years.

Highmark Health Services, a big Blue Cross Blue Shield plan is rolling out its Care Cost Estimator, a transparency tool designed to get members to make cost-saving choices. The video embedded below does a good job of explaining the tool. In watching it, I’m impressed at just how far these tools have come over the past couple of years.

The site is similar in concept to a travel website like Orbitz. It allows users to select the type of care they need, and then see an array of provider choices and associated costs. The costs include total costs and out-of-pocket costs that are specific to the member. It claims to incorporate all aspects of the benefit design and benefit use to calculate the actual out-of-pocket costs. The site also displays patient reviews of the providers.

The real potential of the site is described at around the 2:20 mark, where the video refers to “reference based benefits,” which set an allowable price for a specific procedure and then make the patient pay anything above that amount. Reference pricing has the potential to produce major cost savings at least for certain procedures. I wasn’t aware that Highmark was utilizing this approach. In any case, in order to make reference-based pricing effective, transparency tools like this are an absolute must.

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I don’t know whether the site is as easy to use and as useful as the video makes it seem. But if so, this is a big step forward for Highmark, its customers and members.


By David E. Williams of the Health Business Group.