Blue Cross And Blue Shield Of Texas Transparency Solution Helps Consumers Better Manage Health Care Services And Costs

Provider Finder Cost Estimator Assists Consumers In Making More Informed Health Care Decisions

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Sep 18, 2014, 12:06 ET

RICHARDSON, Texas, Sept. 18, 2014 /PRNewswire/ -- As consumers look for new ways to obtain the best possible care and lower their health care costs, Blue Cross and Blue Shield of Texas (BCBSTX), the largest provider of health benefits in the state, announces the enhanced Provider Finder, an online health care solution developed to enable members to more easily research and select physicians and hospitals, as well as estimate out-of-pocket health care costs. The Provider Finder provides cost estimates for more than 400 common medical procedures, increasing to 1600 by the end of the year.

Provider Finder allows members to search and compare more than 400,000 health professionals and 21,000 facilities nationwide, estimate treatment costs, access clinical quality data and read and write patient reviews. BCBSTX analyzed the use of Provider Finder for approximately 800,000 members and found that members who acted on a Provider Finder recommendation saved on average $900 per procedure.¹

"Our Provider Finder solution provides members access to the information they most often want when they are searching for a physician and need to know how much their care will cost," said Dr. Dan McCoy, Chief Medical Officer, BCBSTX. "Our commitment to improving healthcare transparency is part of our holistic approach to provide our members with the critical information and tools to help them make the best decisions for themselves and their families."

Recent research indicates that consumers may pay as much as 683 percent more for the same medical procedures, in the same town, depending on the facility they choose.² For example, the total cost for a knee replacement in the Dallas area could range from $18,801 to $47,324 depending on the facility.³ The Provider Finder offers members a simple, easy to navigate website, to help in selecting the best provider for their needs, based on location, clinical quality and costs. A few unique features include:

Out-of-pocket costs. Unlike other transparency solutions that rely on estimated costs, the Provider Finder uses an expansive, proprietary database to provide information on out-of-pocket expenses. Out-of-pocket estimates are based on a member's own health plan benefits including health reimbursement and health savings account balances.
Unparalleled provider demographic data. The Provider Finder includes a large library of patient reviews of physicians and facilities, as well as photos and information on average wait times and physician training, expertise and awards.
Extensive Provider Clinical Quality Data. Members can evaluate the quality of care with data from Blue Distinction/Blue Distinction+ Centers, Bridges to Excellence, National Committee for Quality Assurance (NCQA) distinctions and Physician Quality Measurement data.

"Our goal is to optimize the value of health care for our members and the entire health system by advocating for quality care at lower costs," added McCoy. "By providing information on clinical quality, patient outcomes and satisfaction, we empower our members to make better informed health care decisions, which we believe can help drive higher quality experiences and lower out-of-pocket costs for the consumer."

The Provider Finder is part of a suite of custom solutions to engage and empower members to make smart health care decisions. Provider Finder is available to more than 4 million group members of Blue Cross and Blue Shield Texas via Blue Access For Members and will expand to allow access to all group PPO and HMO members by the end of 2014.

In addition to the Provider Finder, our transparency suite includes Benefit Value Advisors (BVA), specially trained customer service advocates who use Provider Finder and other tools to provide consumers various health care choices; Reference Based Pricing, a solution which uses plan design elements to motivate members to understand the cost of certain procedures; and other proprietary tools to provide consumers with choices that allow them to maximize their health care benefits.

About Blue Cross and Blue Shield of Texas

Blue Cross and Blue Shield of Texas (BCBSTX) – the only statewide, customer-owned health insurer in Texas – is the largest provider of health benefits in the state, working with nearly 80,000 physicians and 500 hospitals to serve 5 million members in all 254 counties. BCBSTX is a Division of Health Care Service Corporation (which operates Blue Cross and Blue Shield plans in Texas, Illinois, Montana, Oklahoma and New Mexico), the country's largest customer-owned health insurer and fourth largest health insurer overall. Health Care Service Corporation is a Mutual Legal Reserve Company and an Independent Licensee of the Blue Cross and Blue Shield Association.

¹ Saving Opportunities are based on health claims measured in allowed dollars incurred 3/1/2012-2/28/2013 and paid through 5/31/2013 for HCSC PPO group members.
² Change: healthcare 2011 Transparency Index Study
³ Note that dollars stated are allowed dollars, not patient share. The providers were within a 10 mile radius of zip code 75201

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SOURCE Blue Cross and Blue Shield of Texas