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In a move to reduce costs, Aetna is now charging members in some plans based on the costs of the hospitals they choose, according to the CT Mirror. For example, in the program women who choose to give birth at Midstate Hospital will pay almost 35% of their bill in coinsurance; those who deliver at Dempsey will pay 10%. More common in other states cost sharing tiers is a tool used by payers to steer patients to less expensive care, although other states’ plans generally emphasize the quality of care as well as cost. Early evidence on tiers from other states is mixed. In Massachusetts, the state employee plan implemented tiered physician payments in 2007. A recent study found that only about half of members are aware of the cost differential, most do not trust managed care companies to rank providers, but most of those who learn the information before their first visit use it to choose a physician. The Maine Health Management Coalition, a group of over 50 employers, has used quality-based purchasing tools to improve health care value for all Mainers since2007, providing a trusted source of both quality and cost information to let consumers drive the market. The Coalition has an impressive history of success in both reducing costs and improving the quality of care for every patient. For more on the potential of value-based purchasing, go to CSG/ERC’s Value over Volume site.
Ellen Andrews