The state’s three biggest health insurers are doing a mediocre job of meeting a state requirement to give consumers estimates of what their care will cost, according to an evaluation being released Tuesday by the advocacy group Health Care for All.
Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care, and Tufts Health Plan are obeying the law, but all need to step up their game online if they want to help consumers make prudent choices, said Amy Whitcomb Slemmer, executive director of Health Care for All.
“There was an awful lot of room for improvement,” Whitcomb Slemmer said of the insurers’ cost-estimating websites. “Not one was intuitive.”
For example, on each of the sites it was not obvious how to locate the page containing price information. Tufts and Harvard Pilgrim had no information about the cost of inpatient procedures. Blue Cross gave an estimate of the total cost of a service but, for most enrollees, did not specify how much the patient would have to pay.
The price transparency requirement is a key feature of the state’s landmark 2012 law that was intended to control health care costs. With advance information about prices, the theory holds, consumers will shop around for the best value. Pricing is especially important to consumers as health plans increasingly require patients to pay a greater share of their costs.
Doctors, hospitals, and health insurers are all required to provide cost estimates upon request.
The Health Care for All report is the second analysis in less than a month to find fault with the law’s implementation. Three weeks ago, the Pioneer Institute , a public policy think tank, released a survey of 22 hospitals that found that nearly all were unable to answer questions about cost within two business days as required.
To conduct its evaluation, Health Care for All developed its own criteria for accessibility, comprehensiveness, and usefulness in guiding decisions. Staff members visited the websites of the three biggest insurers, which together cover four out of every five people with health insurance in Massachusetts. They searched for cost information on about 20 common conditions and procedures, such as diabetes care or knee replacement, and graded each plan on each criterion. Overall, Blue Cross got a grade of C-, while Harvard Pilgrim and Tufts each got a C.
The survey found quirks that might quickly defeat consumers. For example, on the Tufts site searching for “MRI chest” will provide no answers; it is necessary to type “MRI of the chest.” Blue Cross had no information on behavioral health costs and prescription drugs.
But Harvard Pilgrim and Tufts won praise for clearly showing the cost to the patient and comparing providers, and Blue Cross got a high mark for detailed information about providers.
“It’s a work in progress,” said Bill Gerlach, Blue Cross’s senior director of consumer engagement solutions. Blue Cross has worked on “significant enhancements” that will be online by the end of the year, he said.
“We’re trying to really empower consumers to be better health care consumers,” he said. “This stuff is new. It’s going to take time to get them up to speed.”
He noted that those who can’t get what they need online can get cost estimates by phone. The cost-estimating website gets 70,000 to 75,000 hits per month, a fraction of Blue Cross’s 2.3 million subscribers.
Asked to comment, Tufts and Harvard Pilgrim e-mailed statements saying they are committed to providing price information to consumers and will continue to refine and improve their sites.
Pete Fullerton, spokesman for the state Office of Consumer Affairs and Business Regulation, said the law does not specify a penalty for failing to meet its transparency requirements.
Barbara Anthony, who championed the transparency provision in her previous role as the state’s undersecretary of consumer affairs, said it is essential for insurers to make their cost information easy to find and use, and to publicize that it is available.
“You cannot build it and expect people to come. You must give them a road map,” said Anthony, who is now a senior fellow in health care with the Pioneer Institute.
But all this work is for “a lost cause,” said Alan P. Sager, professor and director of the Health Reform Program at the Boston University School of Public Health. Giving consumers price information won’t reduce costs, he said, because “it shoots at the wrong target.”
Even if consumers get better information on quality and price, they still rely on doctors to tell them what care they need, and they are unlikely to make dispassionate price-based decisions about matters of health, Sager said. Wealthy people won’t be influenced by price, he said, and poor people won’t choose more appropriate care — they will cut back on it all, including care they need. He called higher deductibles and copayments “a tax on the sick.”
Lynn Quincy, associate director of health policy at Consumers Union, agreed that consumers “aren’t going to move the market.” And price transparency won’t “fix the irrational pricing we have,” she said — but it will expose it to policy makers. Also it’s only fair to reveal the costs, she said: “There’s no reason for it to be opaque.”