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New insurance tools will let patients discover costs

Harvard Pilgrim’s CEO Eric Schultz says, “These tools are absolutely essential.”Barry Chin/Globe Staff

WELLESLEY — If you’re trying to find a doctor, the cheapest place to get a back MRI, or how much is left on the ­deductible under your health insurance plan, help is on the way.

Getting basic health care information, such as comparing the costs of physician visits and medical procedures, has long been a formidable task requiring multiple — and often fruitless — calls to doctors’ offices and insurer help lines. For ordinary patients, it’s like seeking access to military secrets or the ranking factors in search engine algorithms.

But spurred by growing consumer demand and a new Massachusetts law requiring greater “transparency” by medical care providers and insurers, health plans are preparing to roll out online tools that will enable their members to identify medical specialists and comparison-shop for procedures ranging from hip replacements to obstetrics and gynecologic care.


“This is a giant step forward for the transparency agenda,” said Eric H. Schultz, chief executive of Harvard Pilgrim Health Care, the state’s second-largest health insurance carrier. “These tools are absolutely essential to harness the economic power of consumers.”

Harvard Pilgrim, based in Wellesley, plans to introduce a software application on its website this spring called “Now iKnow,” available to its 1.2 million members in Massachusetts, New Hampshire, and Maine. The program, which eventually will also be offered as a stand-alone mobile app, is designed to help people make better decisions by ranking doctors and hospitals based on cost and quality and rewarding the providers offering the best value.

Now iKnow will present consumers with options in simplified fashion customized for their insurance plan, showing, for example, how much they have spent to date on deductibles and how much more they have to spend out of pocket before their insurance kicks in. For each service, it will list a range of pricing estimates, showing both the total cost of the visit or procedure and the amount to be borne by the individual.


“It creates a competitive force that hasn’t existed in the health care industry,” Schultz said. “Those who demand the service will now have the cost and quality information.”

Harvard Pilgrim has been a leader in the burgeoning movement to control medical costs and improve quality by arming consumers with information. Last year, it introduced a rewards program called SaveOn through which members, who have been given referrals for imaging tests and other procedures by their doctors, are invited to contact a “clinical concierge” service that directs them to hospitals or facilities that charge less for the same tests. In return, members receive a check from Harvard Pilgrim, ranging from $10 to $75.

Other health insurers in Massachusetts are working on their own online tools, responding in part to the payment overhaul law passed by the state Legislature in 2012 that requires them to make price information available within two days effective Oct. 1, and immediately by the same date in 2014.

“We’re aiming to get to that real-time world ahead of schedule because that’s what our members want and that’s what they need,” said Derek Abruzzese, vice president of product and strategy for Tufts Health Plan, which is readying a new online cost estimator and member support tools to assist its 1 million subscribers in navigating a growing pool of health plan designs. Tufts, based in Watertown, plans to launch the new tools in the second or third quarter of this year.


But consumers remain frustrated by the array of health care plans and choices, and the difficulty in finding easy-to-comprehend information, said Amy Whitcomb Slemmer, executive director of Health Care for All, a consumer advocacy group in Boston. While she applauds the online tools being developed, Whitcomb Slemmer called for a single state website that would aggregate cost information. She said the data should also be made available over the phone and through printed materials for consumers who are not online or adept at taking advantage of the new technology.

“We hear from the people who’ve had a bad go in trying to sort it out,” she said. “People are beginning to understand that knowing what something’s going to cost before they sign up for it is important.”

Whitcomb Slemmer called on the insurance companies to also offer information on first-time success and recovery rates for various procedures and treatments, which contribute to long-term health care costs.

Abruzzese said a big driver of the online tools is a proliferation of new insurance products, ranging from tiered-network plans that charge different prices for using different doctors and hospitals, to limited-network plans that restrict members to certain providers, to high-deductible plans that offer lower premiums but require members to pay more out-of-pocket expenses. Such plans, some of which are relatively new to the Massachusetts market, require a deeper level of consumer information, he said.

“The health care market up until now has been very different from other markets in the lack of transparency,” Abruzzese said. “It’s easier for people to know what a television costs.”


Blue Cross Blue Shield of Massachusetts, the state’s largest health insurer, is upgrading online self-service for its 2.8 million members. A new cost estimator tool called “Find a Doctor” will be rolled out to preferred provider organization members from select employers next month and extended to all PPO members by July. The tool, which will be offered to health maintenance organization members later this year or early 2014, will help consumers find providers and compare out-of-pocket expenses for 128 common medical services.

Separately, the Boston-based insurer is preparing “a very plain English version” of its explanation of benefits form, said chief operating officer Bruce M. Bullen.

“We take this very seriously,” Bullen said. “There are products structured now with different levels of cost sharing, and members want to know where they can find a quality provider and how much it’s going to cost them. We have an obligation to provide that information to members.”

Bullen said online services, as they are adopted and put to use by consumers, have the ­potential to make the health care system more efficient — and rein in runaway expenses.

“The cost question can only really be addressed by shared responsibility,” he said. “We think people will make rational decisions balancing quality and cost.”

Robert Weisman can be reached at