Health insurance companies are interested in saving money. Sometimes, they achieve this by denying claims. A health insurer in Massachusetts is trying something different. The insurer will pay patients who save them money by finding less expensive health care options.
Typically, when you purchase a health insurance plan, you pay money to the insurance company. You pay a certain amount of money per month for your premium. Your health insurance company, in return, is supposed to cover at least some of your medical bills. In the past, it was unheard of for an insurer to actually pay their customers for anything.
Soon, health insurance companies who do not spend at least 80% of the money they make from premium payments on medical care for their customers will face a penalty. Those insurers will have to “pay” their customers a rebate on the amount of money that the insurer failed to spend on medical care and on things that actually improve the health of their customers.
Those “payments” are likely to come in the form of a credit to the policyholder’s account. It won’t be a check that people can take to the bank. Health insurance companies don’t pay their customers. The one exception is Harvard Pilgrim Health Care, in Massachusetts. This insurer is trying out an unheard of plan: it will pay patients who are able to find cheaper health care services than what their doctor has recommended.
This new plan is going to start in January of 2012. It is being called a rewards program. It works in a very straightforward way. First, a person visits their doctor, and gets a referral to see a specialist, (or a different doctor).
Instead of doing that, the person calls their insurer’s “clinical concierge” line. This will allow people to find out where they can get the same procedures that their doctor recommended for a lower price. Customers who use this system will be paid anywhere from $10.00 to $75.00 by Harvard Pilgrim Health Care.
This is a very different way of providing something called “concierge care”. Typically, “concierge care” is something that a person pays extra for. That person pays their health insurance company a higher premium, and, in return, gets benefits that are not offered to people who pay a lower amount on their insurance (or who use public health insurance).
“Concierge care” can also be offered to people who can afford to go without health insurance, and who can pay the doctor, directly, for all treatment. These people will get to wait in nicer waiting rooms, and may even be offered coffee. They won’t wait as long as the other people will. They also are, essentially, buying more of the doctor’s time, and therefore, get to have longer, more in-depth, consultations.
It will be interesting to see how this new rewards program that is being used by Harvard Pilgrim Health Care will work out. It could make the health care system more efficient, and perhaps lower costs. It definitely will make patients more informed about their options, (and the cost of those options). On the other hand, some doctors may be concerned that the patients who look for cheaper care will not receive what they actually need.
Image by The Cleveland Kid on Flickr