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February 08. 2013 5:56PM

Harvard Pilgrim calculator helps monitor health care cost

Harvard Pilgrim Health Care is preparing to launch a cost and quality calculator, an online tool designed to allow members to figure health care costs and compare providers.

Eric Schultz, president and CEO of Harvard Pilgrim, said the Now I Know tool will give members a new level of transparency to compare cost and quality.

"We believe that knowledgeable and empowered members are the key to improving quality and reducing the growth in health care spending," Schultz said.

Set to be released later this year, Now I Know will give users financial information on their policy, displaying the deductible and how much of it has been paid. If a patient has paid $300 toward a $2,000 deductible, for example, the screen will show the $1,700 remaining deductible.

Choosing from more than 700 medical procedures listed on the Now I Know site, doctors and hospitals throughout Harvard's network of providers are listed. The user can see how much a provider charges for a given service, and how much they will need to pay out of pocket versus what will be covered.

Beth Roberts, senior vice president of regional markets at Harvard Pilgrim, said the site is a more developed version of a previous Harvard-Pilgrim site, which helped patients find low-cost providers.

"Let's say I needed knee surgery. I could go onto this tool and find out the approximate cost at multiple hospitals and be able to make an informed decision about a cost that feels comfortable to me," Roberts said.

She said what distinguishes the new tool is that it integrates cost and quality, two of the top health care considerations.

"This is for folks who want to do more self-service, plan and get concrete information linked to their plan design," she said. "This gives you cost and quality, but the fact that it links to both is what sets it apart."

The site is intended to save money for both patients and Harvard Pilgrim. Roberts said the nonprofit, which serves more than a million members in Massachusetts, New Hampshire and Maine, will save because of lower payments to providers - the less money a procedure costs, the less money Harvard-Pilgrim is liable for. By choosing their own providers, patients will also be helping to reduce Harvard-Pilgrim's administrative costs, Roberts said.

Location and quality assessment information for each provider are also listed. The site will rate providers based on nationally accepted indicators such as LeapFrog, which provides hospital quality ratings, and U.S. Department of Health ratings.

Dr. William Brewster, an associate medical director for Harvard-Pilgrim in New Hampshire, said the intersection of quality and cost are top concerns for many patients.

"When it comes to medical care, quality is a big deal, and sometimes people are like, 'I don't know that I want to go to the most expensive provider,'" Brewster said. "'And how do I know that they're doing the same quality results?'"

He said the most expensive providers don't always offer the best service. By aggregating several indicators and offering an incentive to providers with Harvard-Pilgrim's "honor roll" system, beneficiaries have a tool for weighing their options.

"We're basically giving (providers) credit for doing the right thing," Brewster said.

Jeanne Ryer, director of Citizens Health Initiative, a new nonprofit that advocates for affordable health care in New Hampshire, said the calculator represents something necessary to creating a health care system that provides quality and value.

"Since its inception, the initiative has said that we all gain when we better understand the quality and cost of our health care," Ryer said.



srios@newstote.com