USA Insurers Telling Members More About Docs

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Aetna, CIGNA Telling Their Members More About Doctors

June 14, 2006 By DIANE LEVICK, Courant Staff Writer

Aetna's members in Connecticut and some other states will be able to

find information online about doctors' prices and quality, starting

this summer, as the company expands a program it piloted in

Cincinnati.

Aetna and other health insurers, including CIGNA, are moving to get

more data to consumers as newer health plans put more decision-making

responsibility - and sometimes more of the costs - in their hands.

Effective Aug. 18, Hartford-based Aetna will provide the prices that

primary care and specialist physicians in Connecticut have agreed to

charge for Aetna members' care. Prices will be given for as many as

30 of the most widely used services by specialty.

Aetna will also give some basic information about care by physicians

to help members compare them.

Aetna, which has about 293,000 Connecticut members, said it will have

price information here on 8,700 physicians, and clinical quality and

efficiency information on 2,400 doctors in the state.

Knowing prices is important because many health plans require

consumers to pay a percentage of the doctor's charges or prescription

drug costs. The data are especially key for " consumer-directed "

plans, which often combine an employer-funded account for the

employee with a high-deductible insurance plan.

The account usually isn't enough to meet the high deductible, so

employees may want to stretch the money in the account as far as

possible to avoid or postpone hundreds or thousands of dollars in out-

of-pocket costs.

Employers are increasingly expected to adopt consumer-directed plans,

and insurers are hoping to encourage the trend with the new consumer

information efforts.

Insurers and employers are also hoping the data will make consumers

more price-conscious about health care, although it's not known how

many people would want to switch doctors to save money.

" In most instances, consumers have no way of determining what a

procedure will cost until they receive the bill, " Aetna chief

executive A. said in a written statement.

Aetna believes consumers should have " the same kind of objective cost

and quality information that is readily available when making other

significant purchases, " such as a car or house, he said.

The quality and efficiency information Aetna is using comes from its

existing " Aexcel " program, a narrower network of physicians chosen

based on those measures to help control rising medical costs.

The measures include prevalence of complications in patients, repeat

procedures and hospital readmission rates.

Aexcel also evaluates doctors on common " best practices, " such as the

proportion of an ob-gyn's patients who have had the recommended

mammograms and doctors' prescribing of cholesterol-lowering drugs for

heart patients.

Aetna says its online program will show prices and clinical quality

and efficiency information in Connecticut, Washington, D.C., northern

Virginia, land, various cities in Ohio, northern Kentucky,

southeast Indiana and south Florida. Aetna will list only price

information in Kansas City, Kansas, and Kansas City, Mo.; Las Vegas;

and Pittsburgh.

Aetna, which launched the price listings in Cincinnati last August,

says it received recommendations from physicians in Connecticut and

several other states before expanding the price information program.

Meanwhile, Bloomfield-based CIGNA HealthCare said last November that

it would give average price ranges for physicians for each type of

office visit or procedure, although the data aren't specific for each

doctor.

In April this year, CIGNA said members in Wichita, Kansas and New

Hampshire could access estimated average cost ranges, by facility,

for common outpatient procedures such as colonoscopy and endoscopy,

and for high-tech radiology services.

UnitedHealth Group says it shows members its actual negotiated prices

for prescription drugs and dental care nationwide. But other price

information is not yet available to Connecticut members.

http://www.courant.com/business/hc-aetna0614.artjun14,0,5637253.story