More than 75 percent of total health care costs cover preventable chronic conditions like diabetes, heart disease, and cancer. The Affordable Care Act (ACA) mandates that self-insured employers and health plans provide common, evidence-based wellness screenings designed to reduce such conditions without charging a copayment, deductible, or co-insurance.
Because health plan sponsors absorb this cost, businesses are looking to devise employee education strategies on ways to identify healthcare providers offering high quality services at the lowest cost. Change Healthcare’s March 2012 Healthcare Transparency Index (HCTI) report concentrates on a subset of ACA-covered preventative services over a 12-month period.
Resulting retrospective claims data analysis demonstrates a huge 755 percent variance in service cost among in-network, credentialed providers. The illustration focused on five key ACA-covered preventative screening services including type 2 diabetes screening, mammography, pap smear testing, preventative colonoscopy, and lipid screening.
Results emphasize the importance of cost transparency for ensuring affordability for plan sponsors and employers. Plan sponsors that empower members with access to cost transparency solutions may potentially garner the strongest value. The most effective approaches employ:
- Proactive messaging and cost-saving alerts.
- Personalization specific to the member’s plan benefit design, utilization, and financial responsibility.
- User-friendly decision support framework that guides the process involved in making a change based on cost while simultaneously comparing quality and convenience ratings.
For an employer of 20,000, the HCTI report estimates an approximate near-term potential annual savings of $100,000 by having members shop for five ACA-preventative services in a more informed manner. This figure does not include additional long-term savings attainable through illness and disease prevention.
To read or download the full report, click here (PDF).