1. Why pricing transparency?
Vast disparities in cost and quality among providers
Consumers want more value for their healthcare dollars
No clear correlation between cost and quality
Employers seeking benefit plan designs that encourage lower-cost, higher value-based consumption

2. Health Cost Estimator+ Overview
Health Advocate’s proprietary pricing transparency solution
Supported by leading-edge technology and data analytics
Multiple data sources for medical cost estimates, including clients’ paid medical claims supplemented by our national database
Provides key information to select the highest-value providers
Users can also compare costs for prescription drugs and dental procedures

3. Available on multiple platforms
Available on multiple platforms including smartphone, tablet and PC
Complete mobile application functionality
Employees can call a Personal Health Advocate for added pricing support

4. Key program features
Medical. Compare costs for medical procedures and services by ZIP Code
Prescriptions. Search pharmacies and view out-of-pocket costs before filling a prescription
Dental. Compare and view estimated out-of-pocket costs for dental procedures

5. Key program features (continued)
Consumer-friendly design
Proactive employee awareness and engagement program
Detailed reporting package
Competitively priced; no implementation fees

6. Key program features (continued)
Personal Health Advocates Can Help
Search for and locate qualified providers
Make appointments
Transfer medical records
Facilitate pre-authorizations
Help with next steps
Answer questions

7. Medical Procedures + Services

8. Medical cost transparency
Pricing estimates for doctors, hospitals and other facilities nationwide
Real-time out-of-pocket estimates and user benefit status
Quality indicators, safety scores and patient reviews
Incentive tracking and rewards program
Ability to integrate Reference-Based Pricing

9. Data-driven solution
Shows actual client data based on paid medical claims
Total estimated cost includes the entire episode of treatment, including professional and facility costs
When client-specific claims data is not available for a specific service, uses “same-payer,” “Adjusted Medicare” or “all commercial” data from our database

10. Data-driven solution (continued)
Some carriers restrict the use of data in transparency tools (i.e. most Blues plans and UHC)
Several clients have successfully persuaded their health plan to allow us access to their data for transparency
For clients with Blues plans, we can populate HCE+ using the BCBS Association’s National Consumer Cost Tool (NCCT) data for over 500 procedures

11. Sophisticated search engine
Compare costs for hundreds of medical procedures and services nationwide

12. Real-time benefit status
Personalized benefits information based on paid medical claims

13. View results by hospital, facility
Results Include:
Hospitals
Other facilities (e.g., ambulatory surgery centers)
Doctor affiliations
Estimate breakdown
Mapping function

14. Benefit and quality information
Views Include:
Health benefit status
Estimated out-of-pocket costs
Safety scores
Consumer ratings

15. View cost breakdown for each estimate
Details Include:
Doctor fees
Facility fees
Anesthesia fees
Total estimate
Employer/plan pays
Applied benefits

16. Powerful filter to narrow search results
Sort By:
Cost
Quality
Distance
Consumer ratings

17. Health Cost Estimator+ quality indicators
Hospitals
Leapfrog Hospital Safety Scores
Centers for Medicare & Medicaid (CMS) Patient Satisfaction Survey
Average Annual Patient Cases
Doctors
Healthgrades Patient Satisfaction Scores
CMS Quality Indicators
Education; Group Affiliations
Pursuing sources for clinical quality indicators

18. View results by location
Weigh cost and distance
Sometimes a lower cost choice is next to a more expensive one

19. Compare hospitals and doctors
Compare Feature:
Click on the “plus symbol” to batch results

20. View selected hospitals side-by-side
Compare Feature:
Estimated fees
Procedures performed
Safety score
Consumer ratings
Distance
Save information to PDF

21. View results by Doctor/Specialist
Results Include:
Doctor profile
Fee breakdown
Hospital affiliations
Consumer ratings
Map functionality

22. Compare Doctor/Specialists side-by-side
Compare Feature:
Estimated fees
Hospital affiliations
Consumer ratings
Procedures performed
Distance
Quality indicators
Save information to PDF

23. Prescription Drugs

24. Pharmacy cost transparency
Comparison-shop for medications through partnership with OneRX
Compares costs for thousands of drugs nationwide, specific to employees’ insurance plan and location
Results include co-payment amounts, pre-authorization required, cash price with coupons at different pharmacies and over-the-counter options
Helps employees understand cost and insurance implications before filling a prescription
Empowers them to discuss medication options with their doctor before they are prescribed

25. Dental Services

26. Dental cost transparency
Compare costs for dental procedures through partnership with FairHealth
Uses FairHealth’s national database of healthcare claims
Estimates reflect professional fees (not negotiated rates available through insurance plans)
View estimated out-of-pocket costs
Employees can control variables to obtain more personalized estimates based on their dental plan

27. Communications & Engagement

28. Turnkey member communications package
Electronic, print and video
Introduce, raise awareness and reinforce utilization
Integrate discussion of cost and quality into employee decisions
Incentive tracking and rewards program
Reference-based pricing customized to users’ benefits

29. Management Reporting

30. Detailed reporting package
Utilization Report
Medical Savings & Incentives Report
Member Incentives Report

31. Key Benefits

32. Key benefits
Reduces healthcare costs and the cost of providing benefits
Empowers employees to become more engaged in their healthcare
Provides key data pre-service, to drive more informed choices
Helps employees understand and plan for their out-of-pocket costs
Helps ensure success of consumer-driven health plans
Convenient, multi-platform access; available 24/7
Seamless integration with all other Health Advocate solutions

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