Why Even Cash Rewards May Not Turn Patients Into Health Care Shoppers | CommonHealth

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Mary Hurley, a mother who is pregnant with her fourth child, does 99% of her shopping online. One of the few things she doesn’t shop for via her computer or phone is health care.
Until now.
Hurley, 36, is trying a website called SmartShopper that her employer, Harvard University, is testing to see if it helps employees choose where to get care and save money. Hurley is shopping for a mammogram.
Employers have tried all kinds of strategies to get patients to act like more savvy consumers when it comes to health care. SmartShopper is among the latest. It’s a rewards program that pays $25 to $500 to patients who pick a lower-price test or procedure such as an MRI, colonoscopy or knee surgery.
When Hurley types her home address in Milton and hits search, she sees 14 hospitals ranked by price. Only two have green rewards buttons next to their names. The site tells Hurley that she will receive $50 if she gets a mammogram at Steward Norwood Hospital and $25 if she selects Beth Israel Deaconess Milton.
Hurley leans toward the latter.
“It’s in my hometown, I know right where it is,” Hurley says. “And I just have stronger brand-name recognition with Beth Israel.” SmartShopper Mary tells Hurley that she will receive $50 if she gets a mammogram at Steward Norwood Hospital and $25 if she selects Beth Israel Deaconess Milton. (Jesse Costa/WBUR)
Still, Hurley says $25 might not be enough of an incentive. She has generous insurance and can have the test done at Dana Farber, a top cancer hospital, or at Massachusetts General Hospital, where she already goes for some care, for her usual $25 copay.
A mammogram at Dana Farber or Mass. General is four to five times more expensive than at Beth Israel Milton, which helps explain the reward. But Hurley’s sister had breast cancer, and she wants what she expects would be the best radiologist reading her test results.
For kicks, Hurley keeps browsing. She scrolls down a list of common elective tests and surgeries, for which prices vary a lot, and clicks on an MRI of the arm. Here Hurley sees more well-known hospitals with the green rewards button. And because this test is more expensive, the cashback rewards are larger. Hurley’s retail radar revs up.
“I’d have no problem going to South Shore Hospital, Newton Wellesley, Beth Israel, Mount Auburn over Brigham and Women’s and Mass. General if I’m going to get 75 bucks, 100 bucks,” Hurley says. “That doesn’t feel like a difficult sell.”
But based on this trial run, Hurley says she does not expect to become a frequent online health care shopper.
“I’m not blown away by the savings right off the bat or by the shopping experience overall,” Hurley says. “It seems pretty limited.”
‘Small Savings, But Real Savings’
There are lots of reasons patients don’t shop for health care. Many follow a doctor’s referral and don’t look at their options. Others, like Hurley, don’t have a reason to compare prices. And some patients who do review the cost of a test may assume that the higher-priced labs or hospitals deliver the best care — even though that is often not the case .
SmartShopper executives say it takes a lot of education and support to turn health plan members into active consumers.
“The reward is critical to getting people curious and engaged the first time,” says Rob Graybill, SmartShopper’s vice president of market strategy. Then, he says, “we’re there, right time, right place when they need that information.”
Hurley’s response is fairly typical of patients offered the SmartShopper tool, says Dr. Ateev Mehrotra, a Harvard Medical School associate professor. His research shows that only about 8% of health plan members from a nationwide sample chose tests or surgery using the site. But they cut spending on those services for their health plans by 2% in one year.
That could add up to hundreds of thousands of dollars for an employer the size of Harvard.
“It’s small savings, but they’re real savings,” Mehrotra says.
And there’s little risk to the employer. Harvard only pays SmartShopper when employees use the site. As of now, SmartShopper says about 250,000 Massachusetts residents have access to the tool through their health plans.
Mehrotra says he expects that number will grow. Here’s why: “We are desperate in the United States for ways to reduce health care spending,” he says.
And the problem employers have to tackle is rising prices.
“It is not that the average American is getting more health care over the last decade. If anything, they’re getting less health care,” Mehrotra says. “So why is health care spending still increasing? It’s because prices are going up faster than inflation.”
Which is why employers want employees to pay more attention to prices. Mehrotra’s research shows rewards don’t save as much as penalties, as in making employees pay the extra cost of a higher-priced test. But employers, including Harvard, worry about workers who might get an MRI or have surgery at a high-cost hospital without realizing they’ll receive a bill that could total thousands of dollars.
“We’re really scared of people making mistakes,” says Dr. Michael Chernew, who chairs Harvard’s Benefits Committee. With SmartShopper, “really the worst that could happen is you don’t get a reward.”
Unless you’re one of Harvard’s expensive hospitals. If SmartShopper works, it will steer Harvard employees and their health care dollars away from Mass. General, Brigham and Women’s and some of Boston’s other best-known hospitals.
Chernew calls SmartShopper “a little bit of a nudge” toward choices that take the enormous price differences between Massachusetts hospitals into account.

This content was originally published here.

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