Consumers increasingly are being encouraged to take charge of their health care, both as a means of improving their health and reining in their costs.
A growing list of apps and gadgets allows consumers to track their steps, log their sleep and monitor their heart rates.
Patients also can monitor their care and shop for services through patient portals and apps maintained by health systems, insurers and others, giving them greater access to their health data than ever before.
The Nebraska Hospital Association, for instance, recently updated its Care Compare tool — nhacarecompare.com — to allow prospective patients to select and compare prices among hospitals for outpatient procedures as well as for inpatient care. And hospitals now are required by the federal government to post their list prices on their websites.
Information about the quality of that care also is more widely available. A Health Affairs survey, for example, found that the percentage of respondents who reported seeing information on physician quality grew substantially over the past decade, from 12% in 2008 to 26% in 2015.
Locally, Nebraska Medicine in 2017 launched its own star-based online rating system for the physicians in its clinics, based on surveys of past and current patients. The rating system, found under the Find a Doctor section of NebraskaMed.com/Doctors, also includes comments from patients.
Still, it can be challenging for consumers to pull together all of the pieces of information needed to get a full picture on costs. That’s an issue at a time when health care costs continue to rise and more consumers have high-deductible health care plans that require them to pay a greater share of the first dollars toward their care.
Here are seven ways consumers can take a more active role in their care and potentially gain more control over costs.
That sounds simplistic, and there certainly are going to be health issues you can’t control. But about half of all American adults, or about 117 million people, have one or more preventable chronic diseases, according to the Centers for Disease Control and Prevention. Further, most health care costs are attributable to chronic conditions, key examples being cardiovascular disease and Type 2 diabetes.
The first step in staying healthy is to make sure you know where you stand healthwise. That starts with knowing your numbers: blood pressure, cholesterol, fasting blood glucose and body mass index, said Lee Handke, CEO of the Nebraska Health Network.
If your numbers don’t meet recommended guidelines, you can focus on changing behaviors, such as getting moderate exercise, following a healthy diet, limiting alcohol and eliminating smoking, in order to modify your risk.
Establish a relationship with a primary care physician
One of the most important steps people can take toward managing their health and costs is finding a primary care physician or care team to partner with, Handke said. Not only can such a team help you clarify health goals and care plans, but also it can answer questions about conditions and medications.
On the flip side, patients need to adhere to prescribed medications and scheduled appointments, Handke said, particularly if they have chronic conditions. Lack of compliance, he said, is a common concern he hears from doctors.
Take advantage of preventive screenings and services
Most health plans must cover certain vaccinations and screenings, including those for diabetes, cholesterol and various cancers, at no cost to patients when they’re delivered by a doctor or other provider in the patient’s plan network. Plenty of people, however, don’t take advantage of them. But catching problems early can keep them — and the costs of treating them — from escalating.
Nebraskans, in particular, should make sure to get recommended screenings for colon cancer, said Margaret Woeppel, the Nebraska Hospital Association’s vice president for quality initiatives.
Colon cancer is at the top of the list of preventable diseases in the state, she said. Colorectal cancer incidence and mortality rates both are higher in Nebraska than in the United States as a whole, according to the Nebraska Department of Health and Human Services.
The American Cancer Society now recommends that people at average risk of colorectal cancer start regular screenings at age 45.
“If you can catch things early, there are so many more options, including complete recovery,” Woeppel said. “And (it) can save you thousands of dollars.”
Your primary care doctor can help you make sure you get the recommended screenings for your age and situation. To make sure you know what preventive services and screenings are covered by your plan, check with your insurer.
Get care at the right place
Dr. Cliff Robertson, chief executive with CHI Health, said one of the biggest errors health care consumers commit is using the wrong site of service for care.
That means saving the emergency room for a real emergency, rather than for a common cold with no complications. “We still see the emergency room used as a place of convenience regardless of the fact that it’s more expensive,” he said.
Instead, consumers can check out an expanded list of more appropriate and less costly options. CHI Health offers virtual care visits for minor illnesses such as sore throats and sinus infections 24/7 via phone or video chat for as little as $10. The health system also has Quick Care locations at Hy-Vee food stores. They offer walk-in service for diagnosis and treatment of simple conditions. Urgent care clinics, some free-standing and others operated by health systems, also offer options for seeking care without appointments, including after hours. Some primary care clinics also hold slots for last-minute appointments. All typically clock in at lower costs than emergency rooms.
However, Dr. Bob Rauner, chief medical officer for Lincoln-based OneHealth Nebraska, said patients should try to stick with a provider with whom they have a relationship in order to avoid added costs.
Know your benefits
Many people immediately tuck their new insurance cards in their wallets or purses when they arrive without a second glance.
To get the most from insurance plans, however, consumers should know what benefits they offer, said Handke, the Nebraska Health Network executive.
The list can include those no-cost preventive services and screenings as well as newer ones, such as discounts on fitness watches and trackers. More Medicare Advantage plans, for instance, now offer added benefits such as free transportation to appointments and free health club memberships. Some plans may offer premium discounts for those who meet certain health goals. Others have even begun to pay incentives to members who hit them.
While there are challenges involved, most industry watchers encourage prospective patients to comparison shop for care and for prescriptions.
The prices hospitals are now required to list aren’t what patients actually pay. Patients with insurance instead will pay a discounted price negotiated by their insurer. Those can vary by insurer and health system, even for the same service.
Therefore, insurers recommend that members contact them or use their tools, which take into account the specifics of their plans, to figure costs. Even nonmembers, however, can get basic cost information, such as the average cost for various treatments and procedures.
Prospective patients also can contact hospital financial counselors to get estimates, particularly for prescheduled services. Hospitals typically offer self-pay options at a discount for people without insurance and for procedures, such as cosmetic ones, that aren’t covered by insurance.
Andy Hale, the hospital association’s vice president for advocacy, said those in financial need also can contact hospital financial advisers to work out payment plans.
Newer on the market are health care marketplaces. CHI Health last year began offering a program called MDSave that allows people to purchase vouchers for medical procedures beforehand. Prices are up to 60% off what the health system would bill insurance.
Paul Ketchel, MDSave’s CEO, said patients seeking estimates from an insurer or provider should make sure they include charges for all of the providers who will be involved in a procedure. For a CT scan, for example, patients need to know both the cost of the scan and the radiologist’s fee for reading it. MDSave bundles those charges into one package.
Trent Booher, CHI Health’s division vice president for payer strategy and operations, said the health system has had about $1 million in sales.
Part of the appeal is the system’s ease of use. “Also, I think people appreciate knowing the price upfront,” he said.
He said he particularly likes to see use of preventive services, the kind that patients might skip because of concerns about cost. The health system’s top seller by volume is a comprehensive metabolic panel. They’re also seeing quite a few patients purchase nutrition counseling.
“I have to imagine that’s benefiting the patient in the long run and improving overall health,” he said.
Industry watchers also advise shopping for prescription drugs. Rauner, the Lincoln physician, said he uses www.GoodRx.com to find lower cost medications. It lists the cash prices of medicines at area pharmacies and provides coupons for discounts. Rauner said one recent prescription would have cost $241 using his pharmacy benefit card. The GoodRx price was $101.
The downside: Because such purchases aren’t processed through insurance, they typically don’t count toward a purchaser’s deductible. Some insurance plans allow members to submit costs manually, but it does involve added work, he said.
Rauner also advised asking hospital specialists to send lab tests to independent laboratories, which typically charge less than hospital labs.
Learn the language
Some people have trouble understanding basic health insurance terms. But understanding terms such as copayment and deductible can help members maximize their benefits and potentially avoid unnecessary costs, according to Dr. Tony Sun, chief medical officer at UnitedHealthcare of Nebraska.
For a glossary of health care terms, visit justplainclear.com.