Transparency tools can play an important role in helping consumers make good choices about their health care while lowering costs. At Meritain Health®, we’re lucky to work with a variety of quality products to help in these areas. Today, we’re shining a spotlight on Healthcare Bluebook, a transparency tool that helps employees find the cost of common medical procedures and determine where to get the best care at the best price. It’s a powerful tool that helps both employers and employees save on what they’re spending and build confidence in health care choices they’re making.
Why are transparency tools necessary?
A growing number of people are paying out-of-pocket for medical procedures, the cost of which can widely vary. Many aren’t even aware of how much they’ll spend on a procedure until it’s too late, which can come as a shock. Plus, many people don’t realize it’s often not the doctor who determines cost—it’s the facility where procedures are being performed.
What is Healthcare Bluebook?
Healthcare Bluebook is both a web and app-based tool that enables consumers to access quality and cost information to help make good decisions about their health. Users can look up pricing information, such as fees for a medical procedure and can compare and select the highest-value provider.
For employers, this can lead to lower medical benefits spending and improvements in quality of care. For employees, tools like these provide the information needed to seek quality care at a better price. More importantly, it empowers them to make better decisions for themselves and their families regarding their health care.
How does it work?
From the convenience of a computer or smart device, you can see cost and quality ratings on hundreds of procedures across thousands of hospitals nationwide. Healthcare Bluebook also has a member services team available to answer questions. They can be reached at firstname.lastname@example.org or by calling 1.800.341.0504.
Simple to understand with green, yellow or red
To help identify where a facility falls in comparison to the Fair Price, color-coded cost symbols denote cost rankings for facilities. Additionally, color-coded quality checkmarks indicate the facility quality rankings for inpatient procedures.
- Green: shows a hospital or facility charges at or below the fair price for a procedure by cost. It’s also used to indicate a facility is performing among the top third of all US hospitals or facilities for that specific procedure.
- Yellow: means a hospital charges slightly above the fair price or falls in the middle third of all hospitals.
- Red: indicates a hospital charges a high price or is among the lowest performing third of all US hospitals.
The Healthcare Bluebook Fair Price is the reasonable amount you should expect to pay for a medical service. It’s calculated from an independent, nationwide database of medical payment data and can be customized by geographic area.
This means you’ll be able to find high-quality providers at a Fair Price, saving you hundreds or thousands of dollars on common medical procedures!
The Healthcare Bluebook hospital quality rankings are designed to help patients understand each hospital’s specific level of quality for a particular clinical area or procedure. The Bluebook quality ranking is based on patient specific outcomes calculated for every US hospital, in each clinical area. The Bluebook hospital quality ranking is calculated for each clinical area by combining a hospital’s performance in several areas related to the outcome of the provided services: complications, mortality, and unplanned encounters post intervention. All metrics are risk and volume adjusted.
Healthcare Bluebook programs
Healthcare Bluebook offers a variety of programs to help consumers get the most from their health care plan. It’s also a way to empower employees with incentives to utilize lower-cost facilities. See what’s available below. With all programs, it’s important to note procedures and reward amounts are subject to change.
Members can look up information on facility cost, facility quality and doctor quality. Information is available online, via the Healthcare Bluebook app and by calling Healthcare Bluebook member support.
This provides an incentive for members who choose high-value providers that charge at or below the Fair Price for select health care services. There are over 150 rewardable outpatient procedure codes which can earn participants a monetary reward of $25 to $100 mailed to them by check.
Members who research on HCBB’s site within 12 months of the date of service and then use a “green” facility from one of over 400 outpatient and inpatient procedure codes eligible will receive a monetary reward up to $1,500. Procedures that cost less than the Fair Price are eligible for the incentive. Incentive is paid at the end of the month following payment by Meritain Health.
Members who research on HCBB’s site within three months of the date of service, and then utilize a green facility for one of the over 400 outpatient and inpatient procedure codes will receive a better benefit level once the claim processes at Meritain Health. The eligible service and all related claims for that date of service will process with the better benefit level. The better benefit level is determined by the plan sponsor.
This service provides members who call Healthcare Bluebook concierge support (when needed) to find a lower cost, higher quality provider. Concierge support is for members who need complex procedures. It gives them access to a personal concierge who walks them through every step of the process, i.e., finding a provider, scheduling appointments, managing medical records and providing support throughout the member’s care journey. In return, members are rewarded for using high-quality, lower-cost providers. Bluebook CareConnect can be added to Engagement Rewards or EngagePlus for the enhanced member support and case rates apply when utilized.
This is a reference-based pricing program on certain procedures, where Healthcare Bluebook sets the reference price. Any amounts above the SmartSelect allowable amount becomes the member’s responsibility, which does not apply to maximum out-of-pocket limits.
Being a better health care consumer
High cost does not equal high quality. By letting you see the quality and cost ratings before committing to a procedure, Healthcare Bluebook empowers you to be a better health care consumer and advocate for yourself and your family!
Contact your Meritain Health representative if you’d like more information about Healthcare Bluebook or visit www.healthcarebluebook.com.
This article is for informational purposes only and is not meant as medical advice.