eviCore's SmartChoice Program
The future of healthcare lies in developing smart consumers: patients who are able to make intelligent, economically informed decisions about their healthcare. One way to help accomplish this is to promote the price transparency of costly medical procedures. By providing patients with comparative cost information about their medical procedure from various facilities and hospitals, this would better equip and motivate the patient to choose the lower-cost facility. More times than not, that same medical procedure might cost, on average, $1,100 less at a nearby facility than at the hospital. In short, identifying a clinically equivalent but lower-cost option should ultimately reduce the overall cost of a patient's treatment plan.
The SmartChoice program was established to better engage patients and provide them with necessary clinical and price transparency knowledge regarding their upcoming medical procedures. It specifically gives patients access to information on locations where they might receive a medically appropriate MRI, CT, or PET scan. This program has increased (1) patient satisfaction by enabling them with additional visibility and control of their healthcare and (2) provider satisfaction by providing them with the knowledge that their patients are going to the most cost-effective facility. This program has also created a huge cost-savings benefit for both health plans and patients alike.
Defining the Challenges
Around 2011, the exponential growth in the number of high-deductible plan subscriptions had incentivized both the patients and the health plans to drive down total healthcare costs and increase price transparency in the industry.
Unlike medication cost transparency, figuring out exactly how much a medical procedure will cost is harder than one might think. And while patients are expected to make the most economical decisions when it comes to their healthcare, they may not have the appropriate access to tools to do so. For example, a patient in need of diagnostic imaging has facility options and for some procedures of equal quality, there are large variations in cost between hospitals and standalone imaging centers, with the price difference sometimes reaching as high as $1,142.
Patient education, or the lack thereof, contributes to the continuous cycle of choosing a hospital setting for diagnostic imaging instead of a standalone imaging center. So we ask ourselves, "Why not inform patients, prior to their medical procedure, of the equality in clinical value and the extreme price differential between imaging sites?" Well, it is crystal clear that additional patient education is needed around the potential savings opportunities inherent in a move from a hospital to a standalone imaging facility.
Applying an Easy Solution
eviCore's SmartChoice program serves as a solution that educates and informs the patient. We employ specialized patient-outreach services that educate health plan patients about procedure location options. This timely service begins as soon as the patient leaves their doctor's office. An eviCore patient service representative contacts the patient upon receiving the procedure approval. They act as a concierge to the patient by providing information such as: same-quality facility availability, the cost of services at each facility (free-standing or hospital), and appointment coordination. Once the patient decides on their facility preference, our patient service representative contacts the facility, schedules the appointment, and notifies the patient's provider of the updated appointment. It is that easy.
eviCore's SmartChoice program was the first of its kind developed specifically to help patients become smarter consumers. Obviously, in some ways the U.S. healthcare system is "broken," so this is a way to apply some fixes and add transparency to cost-savings analysis. Additionally, SmartChoice helps fill in the gaps in consumer education by effectively highlighting cost variability between treatment diagnostic facilities.
Increased Cost Savings
With rising healthcare costs and the program's increased utilization, SmartChoice has gained greater impact over its lifetime. In 2016, the cost savings totaled $38.8 million, a $5 million increase from 2015 (Figure 1). eviCore projects a continued increase in the level of cost savings realized by this program.
Note that eviCore's program offers huge member savings potential. Member savings per conversion went from $148 in 2012 to around $374 on average saved per conversion in 2016 (Figure 2).
Today's healthcare environment is more complex and patients require a thorough understanding of the quality and value of their health services. They need an ally to navigate this multifaceted healthcare landscape. With the SmartChoice program, health plans can rely on eviCore as a sound partner who is committed to ensuring that your members are well informed to make important choices regarding their health. Learn more about how eviCore is empowering the improvement of care for members.