Right to Shop – the Next Big Thing in Healthcare

February 11, 2018 by  

Forbes’ article on Right to Shop – It’s the next big thing in Health Care –  is spot on!  And SB 1471 can make it happen in Arizona.  Check out how Jenny saves thousands every year  while managing her Crohn’s disease. But she doesn’t just save – under an insurance incentive program offered in New Hampshire and switching to a lower cost provider, she actually gets paid $500 per visit and pays no copay. Same drug, same delivery, same frequency, but higher quality one-on-one care at a fraction of the cost. See her story on NBC Nightly News.

Why do we need Right to Shop?  Frankly, health care is eating up our paychecks and there is no relief in sight.

• High Costs Hurt Sick Patients: Patients are struggling to pay for health care.

• Little Transparency: Prices for health care can vary by thousands of dollars for an identical service of the same quality. Right now it is like gas being sold at one station for $2.50 but at another for $20.00, but having no idea before you fill up. In other words, where you park your car really matters yet patients are in the dark about what health care services cost.

• No Reward for Doing the Right Thing: Patients, doctors, and caregivers are not rewarded when high value (high-quality, lower-cost) health care is provided or used.  Plus most of us – 7 out of 10 – believe insurance companies are not working to keep costs down.
What is Right to Shop?   It gives patients the information they need to make informed choices, helps those with chronic conditions contain their costs, can lower health premiums and aids small businesses to save money to hire more workers through lower insurance costs.

Right to Shop will help to reduce the cost of health care, thereby reducing the cost of health insurance.  It gives Americans more money in their wallet to pay for other family expenses like school, gas and food.    The state of Maine passed Right to Shop with unanimous bipartisan support in 2017.

How Right to Shop works:  Price Transparency Tools, which are readily available to insurers now – help patients get an estimate from their insurer of their price options ahead of time. They will be able to get this on a website or from a toll-free call in number.

Why it Matters?  Patients need transparency to pick the best value provider. Thousands of common procedures are currently shopped by transparency companies for their big business clients.  Right to Shop opens that option for individuals and small business employees.

The Incentive:  Armed with price and quality information, patients can choose a low, moderate or higher cost provider for the non-emergency health care service and reap part of the savings the insurer realizes when they choose lower cost options as their incentive reward.  It’s up to the insurer how those rewards are structured.

Another Real-life Example:  I need an MRI for my knee. I am unaware that my insurer will pay one facility $425 for that MRI and another $1,500 for the exact same thing. Since I am paying out of my pocket for the MRI, with Right to Shop my insurer needs to tell me what they are paying each provider under my specific plan in order for me to pick the best provider.
Insurers will share savings with a patient when they pick a good value provider.

Prices can vary by hundreds or thousands for the same thing a couple miles away. Patients should share in the saving when they shop, which will lower health premiums. Many big companies offer rewards now, this bill simply expands that to individuals and small business employees.

Why shouldn’t Arizona patients benefit from similar savings?   SB 1471 passed the Senate Health and Human Services Committee and continues to gain support as the bill moves through the legislative process.




One Response to “Right to Shop – the Next Big Thing in Healthcare”
  1. Christina Dumal,DVM says:

    This is an excellent idea. Oh could I tell you some stories when I started shopping around for an ultra sound since it was an out of pocket expense. Most people don’t know that they can shop around, and it can be confusing for many. Your bill will put the onus on the insurer. Keep up the good work Senator!

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