Meritain Health® - In the Booth

Healthcare Bluebook SmartSelect

December 11, 2019 Meritain Health - Bridgette Cassety, Director of Broker Engagement, and Will Goudreau, Senior Strategic Consultant Season 1 Episode 1
Meritain Health® - In the Booth
Healthcare Bluebook SmartSelect
Chapters
Meritain Health® - In the Booth
Healthcare Bluebook SmartSelect
Dec 11, 2019 Season 1 Episode 1
Meritain Health - Bridgette Cassety, Director of Broker Engagement, and Will Goudreau, Senior Strategic Consultant

Learn how SmartSelect reduces the total cost of care for the member and the plan sponsor without reducing any type of quality, or creating risk.

Show Notes Transcript

Learn how SmartSelect reduces the total cost of care for the member and the plan sponsor without reducing any type of quality, or creating risk.

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BC: Welcome to In the Booth. My name is Bridgette Cassety, and I'm the Director of Broker Engagement here at Meritain Health and thank you for joining us today for a discussion with Will Goudreau. He is one of our senior product strategists here at Meritain, and we're here to have a conversation with you today about Healthcare Bluebook SmartSelect program. So thank you Will so much for being with me today and spending a few minutes so that we can better understand the SmartSelect program and what it has to offer for clients and members to manage their total cost of care. So with that, Will,  I thought to kick things off, if you could just give it a quick overview of how SmartSelect works, so everyone has a little bit of working knowledge and knows what it's all about.

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WG: Sure, thanks, Bridgette. So the SmartSelect program is a reference price program where a dollar amount is set for a procedure that if the charge is over that amount, the plan will not pay the difference; that will become member responsibility. So the procedures that are used in this program are certain outpatient procedures where there's little difference in quality, but there can be great difference in cost. So things like CTs and MRIs, arthroscopic surgery on a knee or shoulder, colonoscopies. Very common procedures, the procedures that are planned ahead of time. Not emergency care or Urgent care, but things that the member plans to get done and could do research. So where the providers have the best cost or what the differences are and they can pick a better provider. If they don't pick a lower cost provider then the plan is limited on what they'll pay for that procedure.

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BC: So Will, it sounds like what you're talking about is that the plan provides is what I guess I would define is an allowable amount that would be reimbursed to the member. Is that a good way to think about it? 

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WG:Yeah, so the reference price, the allowable amount, is set for that procedure in that market. So there's 184 markets throughout the country that where care typically tends to gravitate or orbit and the limit is set for that procedure in that market. So it's right for that area: there's enough providers that the member can choose from to be below that amount but there’s also a lot that are above that amount as well, which is what we're trying to avoid and what we're trying to protect the plan from paying that those higher amounts.Yeah, so the reference price, the allowable amount, is set for that procedure in that market. So there's 184 markets throughout the country that where care typically tends to gravitate or orbit and the limit is set for that procedure in that market. So it's right for that area: there's enough providers that the member can choose from to be below that amount but there’s also a lot that are above that amount as well, which is what we're trying to avoid and what we're trying to protect the plan from paying that those higher amounts.  

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BC:So when you talk about, Will, these 184 different markets, what that allows for someone who lives in more of a rural area or a secondary market versus a high metropolitan area. A product like SmartSelect would really distinguish the difference between those markets and reimbursement would be relative to the area in which is being rendered So when you talk about, Will, these 184 different markets, what that allows for someone who lives in more of a rural area or a secondary market versus a high metropolitan area. A product like SmartSelect would really distinguish the difference between those markets and reimbursement would be relative to the area in which is being rendered  

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WG:Right. That's right. Like a knee arthroscopy could be, a certain dollar amount in say, Nashville, but in a few hours down the road in St Louis, maybe it's a totally different amount. It's what the providers charge in each area. So the members aren’t being penalized for where they live. It's the allowable amount is set based on where they're from and what providers charge in that area.Right. That's right. Like a knee arthroscopy could be, a certain dollar amount in say, Nashville, but in a few hours down the road in St Louis, maybe it's a totally different amount. It's what the providers charge in each area. So the members aren’t being penalized for where they live. It's the allowable amount is set based on where they're from and what providers charge in that area.  

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BC: So Will, it sounds like, we certainly want our members to be educated consumers. And with that, what tools does Healthcare Bluebook have available for the members to take advantage of and learn about where they can go in which to manage that out of pocket expense for themselves,So Will, it sounds like, we certainly want our members to be educated consumers. And with that, what tools does Healthcare Bluebook have available for the members to take advantage of and learn about where they can go in which to manage that out of pocket expense for themselves,  

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WG: Right. There are three ways that the member can access the information.  The first is through their member portal. So logging onto the Internet and logging into their member portal click through to  Healthcare Bluebook they can easily find the information. They can use their Healthcare Bluebook app on their phone or tablet and search for the same information. Or they can call Healthcare Bluebook and speak to a representative and get the details that they need.Right. There are three ways that the member can access the information.  The first is through their member portal. So logging onto the Internet and logging into their member portal click through to  Healthcare Bluebook they can easily find the information. They can use their Healthcare Bluebook app on their phone or tablet and search for the same information. Or they can call Healthcare Bluebook and speak to a representative and get the details that they need.  

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BC: So certainly Healthcare Bluebook makes it as easy as possible for members to get that information, and I'm sure that most members are going to go down that road because obviously they will manage their out of pocket costs. But what happens with a member that says, that's a great idea, Will, but I really just want to go where I want to go, and I can't be bothered. How did the product like this work with those members sort of are looking for complete flexibility without a lot of engagement So when I think about some of the things that we talked about today, related to the SmartSelect program, it sounds like there's really two key things to keep in mind. It reduces the total cost of care for the member and the plan sponsor without reducing any type of quality or creating risk. Would you say that's a fair summary of the product?

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WG: Yes, That's right. It's a win for the employer because it controls your costs of these procedures. And it could be a win for the member, being better educated for what things costs for these procedures and then also other procedures that are outside of this program, say certain inpatient procedures that they can also get information on cost and also quality.

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BC: Well certainly all of us as consumers and plan sponsors and those of us in the industry want to make sure that we're providing the tools and resources for members to manage their out of pocket costs. Because certainly health care is expensive. So anything we can do to help manage that we certainly want to do. So thank you. Will, I appreciate you joining me today for In the Booth and sharing your knowledge on SmartSelect with our listeners.

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WG: Thanks, Bridgette.Well certainly all of us as consumers and plan sponsors and those of us in the industry want to make sure that we're providing the tools and resources for members to manage their out of pocket costs. Because certainly health care is expensive. So anything we can do to help manage that we certainly want to do. So thank you. Will, I appreciate you joining me today for In the Booth and sharing your knowledge on SmartSelect with our listeners. Thanks, Bridgette. 

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