The cost of coverage

As health-care costs rise, insurers help you sort out where to go, which treatments are worth it

By Colleen LaMay

Idaho’s largest health insurers are offering customers more information about the quality, effectiveness and cost of health care in the Treasure Valley. And customers are more likely to zero in on the information as they pay for an ever-larger share of their own health care.

One in eight new policies at Regence BlueShield of Idaho and Blue Cross of Idaho, the state’s largest insurers, is some version of high-deductible health insurance, often $2,000 or greater, combined with a health savings account.

"The concept behind all of these plans basically is to have the consumer more involved, more ’skin in the game,’ " said Karen Early, director of corporate communications for Blue Cross. "They are more involved because it has a direct financial impact," she said.

Blue Cross gets a lot of inquiries from employers about the tax-advantaged health plans, and more are offering them as an option for their employees. "There is a lot of interest based on cost issues and employers wrestling with health costs," Early said. One company test-driving the health-savings accounts as the only option, replacing traditional coverage, is Healthwise, a Boise-based nonprofit organization that develops patient-friendly health information.

Employees there now have a health plan with a $2,000 deductible. To help employees with some of those "deductible" costs, Healthwise puts $1,750 into a health-savings account, and employees have the option of adding $250 to that. If employees don’t use all the money in their tax-advantaged accounts by the end of the year, it stays there and builds up for use during a year of more ailments, or a big surgery. Employees who have money in their accounts at age 65 can withdraw it and use it any way they want, although it will be taxed as ordinary income.

"Healthwise wants to solve some of those issues that other people might have had with high-deductible plans," said Brenda Foster, director of corporate communications for Healthwise. "It is too soon to say how it is going," she said. The plan has been in place for less than a year.

People with more traditional preferred provider or indemnity plans, which still make up the overwhelming majority of policies, are paying more, too. The cost of insurance in the United States has risen about 11 percent in the past year alone.

No Valley-specific information was available, but premium increases at Regence BlueShield were in the single digits, spokeswoman Georganne Benjamin said. That is because of higher deductible plans; lower utilization of benefits; medical management programs; a new pharmacy program; and an increase in customer use of generic medicines, she said in an e-mail.

The cost of insurance is rising as technology increases the scope of treatments available in the Treasure Valley. "We have increased the volume of things we can do," Early said. "There are a lot of things we can do to keep people well."

Is more care better? That depends. Blue Cross and Regence BlueShield are among insurers, government agencies and consumer groups trying to find ways to rate the quality and cost of care hospitals and doctors provide.

Here is some of the information available from the insurers:

Regence BlueShield’s Web site provides information on the quality of care at Boise hospitals. Information on the effectiveness of treatments is available, as are estimates of the cost. The Web site is accessible only to Regence BlueShield patients.

A new feature for Regence patients is an open forum called My Community, which allows members to interact in real-time discussions on health and lifestyle topics and find helpful community resources.
"Many Web tools provide health information, but no other site combines cost and quality comparisons on hospitals with planning tools — and the ability to integrate this information to individual health-care benefits," Benjamin said via e-mail. "In doing so, we are providing an unmatched, empowering experience that will increase the value of each employee’s health- care dollar."

Regence BlueShield’s hospital comparison data comes from the Subimo health-data company, featured in publications ranging from The New York Times to Modern Healthcare. Regence BlueShield partners with Subimo and other health-care data providers to offer health planning and advice tools on myregence.com.

Subimo’s Web site lets anyone sign up for My Healthcare Advisor for $24 a year. The Web site lets you compare hospitals based on criteria you set, including its experience with a procedure you need. Hospitals can see what is written about them, submit questions and corrections or add to the data. Subimo does not rate doctors.

Blue Cross provides similar information through a link to a company called HealthGrades, which offers provider quality ratings and profiles. The HealthGrades site offers detailed information on how well and how appropriately hospitals treat patients for a variety of conditions. It also provides information on doctors, including professional misconduct, if any, specialties, education and training, board certification and comparisons to national and specialty averages.

Hospital reports on the Web site recently were going for $17.95 for one hospital, with an additional $2.95 for each additional report. Reports on doctors, including professional background, board certification and disciplinary actions, were going for $17.95 for one doctor, $9.95 for each additional doctor. Pay an extra $3.95 to learn how much you might have to pay for up to three procedures your doctor performs. Limited information is available for free. Much of the information from HealthGrades and Subimo is available free from other sources, but takes some digging to find.

Information also is available on how well treatments work. Blue Cross and Blue Shield Association’s Technology Evaluation Center, assesses the effectiveness of treatments. The idea is to help you understand the scientific evidence so you can make informed decisions. Evaluating the quality of treatment doctors and hospitals provide remains a work in progress. "It’s a very difficult thing, rating quality in providers," said Blue Cross’ Early.

Both of Boise’s major nonprofit hospitals provide information on hospital costs for procedures. The amounts do not include charges for medical imaging or physicians, including anesthesiologists. Here are some free Web sites that can help you:

See snapshots of how Idaho stacks up to the rest of the nation in the quality of care it provides for people with heart disease or other common conditions. Go to the to read the comparisons.

See how individual Treasure Valley hospitals compare with national standards and with each other on Hospital Compare, a service of the U.S. Department of Health and Human Services. This tool gives you information on how well Valley hospitals care for adults with pneumonia and other ailments. The information was created through the Centers for Medicare and Medicaid Services, or CMS, and organizations that represent hospitals, doctors, employers, accrediting organizations and the public.

Find the benefits and drawbacks of many new medicines and treatments, as well as step-by-step guidelines for treatment of scores of conditions in the clinical information section of the federal "a href="http://www.ahrq.gov/clinic/">Agency for Healthcare Research. All practice guidelines are clearly dated so you know how old they are. You may need to look up unfamiliar terms. Many health Web sites offer that tool.

Insure.com offers a tool that lets you search, state by state, to see what conditions must be covered and what your rights are.