Byline: Patricia Simms Wisconsin State Journal
Welcome to the brave new world of health insurance.
On this new frontier, customers can:
* View pharmacy claims and the actual costs of prescriptions.
* Find out how much of their deductible they've used.
* Find out which procedures were done and what the charges were.
* Update personal information online.
* Print out medical and pharmaceutical charges for tax purposes.
* Choose a new primary doctor online.
And that's just GO-TO, a Web-based self-service health insurance program that Physicians Plus Insurance Corporation rolled out this spring.
'This will allow a much simpler and more direct way for members to manage their business with us,' said Bill Jollie, chief operating officer of the managed care organization. 'We have a 7 a.m. to 7 p.m. office, but people don't live a 7-to-7 life.'
GO-TO is available at any time -- in real time -- and eliminates some paperwork and waiting times for as many of the 95,000 PPIC members that choose to enroll, Jollie said.
About 350 members have been enrolling each week, he said, and a similar module for health-care providers is near.
Because the detail of actual claims is available online, members are able to see clearly what services were delivered. 'It's going to make people much more conscious of what physicians are doing ... what services physicians are actually billing for,' Jollie said.
GO-TO, developed on software sold by Perot Systems, is the latest local evidence of a sharp shift toward consumer education and choice -- the trendy term is 'consumer-driven health care.'
'This is, in fact, the direction that health-care consumerism is going,' said Susan Pisano, vice president for communications for America's Health Insurance Plans, a Washington, D.C.-based trade organization.
'That means access to more information about cost and quality, more transparency, more choices and customization.'
The technology that's fueling the shift didn't exist 10 years ago, she said.
Last fall, for example, Group Health Cooperative of South Central Wisconsin, another Madison managed care organization, launched a system called GHC MyChart that gives patients access to their medical records.
Employers benefit as well: WPS recently announced it is making data on health-care cost and utilization available to employers via the Internet. Jollie said Physicians Plus debuted a product directed to employers last year, and Christopher Queram, chief executive officer of the Employer Health Care Alliance Cooperative, said the Alliance has offered employers a similar service -- again via the Internet -- since last fall.
'The capabilities and design of these systems vary slightly, but they are all part of the mega-trend of increased access to information,' Queram said.
As the cost of pharmaceuticals and technology soars, health-care companies want patients to know what their pills and products cost.
Pisano said this should be good for consumers. 'I don't think American consumers embrace the idea that one size fits all,' she said. 'Choice is one of the paramount principles for the American consumer. That hasn't necessarily played out in the health-care arena, but it certainly is beginning to.'
In the past, the American health-care system paid the same for bad quality as it did for good, she said. 'The system has not particularly provided the information that allows consumers to drive businesses to the better-quality and lower-cost providers,' she said.
For patients in managed care, which is about 65 percent of the Madison market, GO-TO may be the first time members will get a look at the real cost of the drugs they take, said March Schweitzer, director of product development at Physicians Plus.
'There is a subtle educational component,' Schweitzer said.
Experts think savvy health-care consumers will drive down costs, Pisano said.
'There is a distinct body of opinion that says if you have information on cost and quality, you are going to make good choices based on cost and quality,' she said.
'Ultimately ... good quality costs less than poor quality.'
But it's too early in the evolution to know what impact these systems will have on costs and on individual behavior, Queram said.
'Certainly the hope and the expectation is that information will drive better decision-making and that will impact both cost and quality,' Queram said. '... we have a long journey ahead to create an informed and empowered' consumer. Yet, we are creating the tools and that is, in itself, a positive sign.'
Fore more information, visit www.pplusicdigital.com
Contact Patricia Simms at psimms@madison.com or 252-6126.
