Pulling back the curtain on health care costs

While the COVID-19 pandemic may have brought renewed urgency to the issue, the need for more cost transparency has long been part of the conversation about the future of health care. Beneath the partisan wrangling in Washington lies a serious issue. Not only is health care expensive, but it can be difficult for consumers to know just how much care costs until the final bill arrives.

Managing medical costs starts with knowing what they are in the first place. At Blue Cross and Blue Shield of North Carolina, we support the concept of cost transparency. We’re leading the way in making it a reality, not only for our members, but for all North Carolinians.

It’s hard to believe, but the cost for many common procedures can vary by thousands – in some cases tens of thousands of dollars – within the same city. When consumers don’t have easy access to this information, they are not only in the dark about the total cost of their care, but more importantly how much it will cost them out-of-pocket. A Blue Cross NC analysis showed that some North Carolinians will spend up to 25% of their take-home pay solely on medical expenses. That can be a massive financial burden for families to bear.

An early innovator in cost transparency, Blue Cross NC launched a groundbreaking cost comparison tool in 2012 that enables members to compare cost and quality for common procedures before they make important care decisions. Just as consumers can shop for cars or smart phones by doing research before making a purchase, we’re empowering patients to be better informed health care consumers. When patients see that costs for the same surgery in the same area can vary by as much as $19,000, they realize they can choose more affordable options.

In 2015, we went a step further and made the tool available to all North Carolinians. Everyone in North Carolina, whether they are a Blue Cross NC member or not, can quickly search for common procedures like MRIs, knee replacements or mammograms and see how the cost compares between nearby providers.

In 2018 we launched SmartShopper, a cost saving prescription program that rewards members with cash for choosing high-quality, cost-effective tests or procedures. This personalized online tool helps members compare the quality and cost of over 80 tests and procedures. It also pays them up to $500 for choosing a high-quality, low-cost option.

Higher prices don’t always mean better quality care. When as much as 43% of health care services are actually considered “shoppable,” it can pay off – literally – to comparison shop. Fifty-five percent of U.S. consumers can now find out the cost of a medical procedure before receiving the service, an increase of 11% in just one year (PDF). It only makes sense that giving more shopping power to consumers will, over time, help motivate health care providers to offer more competitive prices for their services.

Emergency rooms are designed for emergencies, yet non-emergency ER visits are driving up the cost of care for everyone. According to Blue Cross NC claims data, the bill for a typical ER visit is about $1,900. What’s more, one study revealed that only 29% of emergency room patients actually required ER-level care. That can be an expensive choice for an upset stomach, mild rash or back pain.

That’s why we educate our members on the right kind of care before they need it and provide them with the tools to access the appropriate care once they do. Urgent care centers offer immediate treatment for issues that need prompt attention but are not life-threatening. And telehealth enables members to make virtual appointments with a doctor 24/7.

To help members decide what type of care is appropriate, Blue Cross NC also offers a 24/7 nurse hotline, Health Line Blue, potentially helping members avoid unnecessary, costly ER visits. Matching the right medical need to the right care option is critical to help lower costs. It also frees up valuable ER resources to focus on helping those who truly need life-saving care.

Blue Cross NC will continue to shine a light on what health care actually costs, just as we will continue to help our members find high-quality, low-cost care options to meet their needs. We want members to know they can easily save money on one of their largest household expenses – while motivating health care providers to offer a better price for their own services. We work hard to give them the tools they need to get the most for their health care dollar.