June 25, 2012
All Blue Cross and Blue Shield of Kansas Contracting ProvidersFrom:
Connie Winkley – Education/Communication Coordinator
Institutional Provider Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association
Blues Release Suite of Consumer Transparency Initiatives in July 2012
The Blue Cross and Blue Shield Association (BCBSA) and partnering Blue plans have collectively agreed to step up the implementation of consumer transparency tools on the roadmap of health care reform initiatives. The consumer transparency tools satisfy the segment of health care reform initiatives where health plans need to provide a means for their members to make informed choices about providers with whom they wish to partner for their health. Members must have the option to compare cost and quality, and to provide feedback to the provider on how they felt about the encounter with the provider, staff and the overall encounter experience.
Today, online shoppers have the option to register comments regarding their experiences with a purchase or service provided, and other shoppers may review these comments as part of their decision-making process for purchasing products or services. The health care consumer wants reliable information to make his/her own informed decisions on what provider or service to choose for his/her health care needs. What does the health care consumer find to be the important aspects in choosing health care providers?
Studies show there are three main elements consumers consider to be important in their health care choices: Cost, Quality, and Experience. Today in the National Doc Finder directory consumers are able to compare providers with the information available. In July 2012, consumers will have additional resources available to assist with evaluating cost, quality and patient experience with a provider. These tools help involve the member in becoming an engaged and more informed consumer when selecting providers as partners for health care.
The purpose of the cost initiative is to provide a “shopping tool” to assist members with health care financial planning and decision-making.
The cost initiative involves two phases. The initial phase is to provide average cost information for a common set of elective services. The member has a choice today in his/her health care and will be able to make better informed decisions in discussions with the provider, and in determining the out-of-pocket expense for the elective service.
The cost data is displayed based on the treatment category and the geographic region the member selects in the inquiry process. In-network provider costs are displayed as a total cost estimate for the elective service for each facility in the geographic region selected.
Greater detail on the treatment categories and how the cost data is calculated will be covered in a separate publication prior to the planned August 2012 implementation.
The second phase involves incorporating the member’s benefits to determine a more detailed outline of the member’s out-of-pocket for the elective service being considered. Phase II is planned for release mid to late 2013.
National quality-based recognition programs (e.g. Bridges to Excellence and American Board of Medical Specialties (ABMS) Maintenance of Certification (MOC®) recognition programs) are currently displayed on the Blue National Doctor and Hospital Finder Website.
The BPR program is designed to reinforce Blue Plans’ commitment to quality by providing more meaningful and consistent information on physician quality improvement and recognition on the National Doctor and Hospital Finder site.
Participation in a local, regional, or national Quality Improvement (QI) or Recognition Program will also qualify a physician (or group/practice) for an overall BPR indicator on the National Doctor and Hospital Finder site.
The BCBSKS local Quality Based Reimbursement program established January 1, 2012 is being used as the recognition program for qualifying providers for a BPR indicator on the National Doctor and Hospital Finder site in 2012. The BCBSKS local physician recognition program will be reviewed annually and updated as needed. The objective of the BPR is to encourage providers to be quality champions at the point of patient care.
The Blue System believes that engaging and empowering consumers to make more knowledgeable health care decisions is a fundamental priority. In the rapidly changing health care environment, consumers need information that can help them take an active role in managing care for themselves and for their families.
The first of the two Patient Experience initiatives is an updated National Doctor and Hospital Finder Website that will include the consumer transparency tools, and is designed based on what consumers believe is important. It is to become a best-in-class tool for consumers of health care. The second of the Patient Experience initiatives is the Patient Review of Physicians (PRP).
PRP is a member tool for reading and writing reviews of physicians and professional providers nationwide. Questions 1 and 2 are required. Consumers may make comments in an open text field. Studies show that 85-90 percent of comments are positive. The comments will be monitored for appropriate use of words and to catch any personal health information from being displayed on the Website. Details on the moderation process are being developed and will be shared prior to the July 2012 release. The table below gives the consumer an idea how the categories, questions and responses that will be presented on the PRP tool.
|1||Overall Experience||How would you rate your overall experience with this doctor?||Point Scale (1-5)|
|2||Recommend||Would you recommend this doctor to your friends and family?||Yes / No|
|3||Communication||How well did the doctor communicate with you about your health concerns?||Point Scale|
|4||Availability||How would you rate the doctor’s availability for your appointment?||Point Scale|
|5||Environment||How would you rate the doctor’s overall practice environment?||Point Scale|
|6||Text Comments||Have additional comments to make about this provider?||Open Text Field|
Complete details for each of the consumer transparency tools will be available in July 2012 prior to implementation of the redesigned National Doc and Hospital Finder that will have incorporated these new tools for providers and members. More information on the Consumer Transparency Tools for BCBSKS members will be forthcoming as it becomes available.