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The Health Care Sweet Spot: Health Plans That Help You Find It

By Kyle Marshall | October 10, 2014 | Healthy Lifestyle, Insurance Education

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Consumer Reports‘ annual health plan rankings came out two weeks ago. While that certainly gets some attention each year, there’s a new section that warrants a closer look if you’re interested in the costly problem of unnecessary medical treatment.

The consumer magazine’s assessment of 507 private health insurance plans now includes a category called “Avoiding Overuse.” If a plan meets certain criteria, such as reducing the overuse of invasive heart procedures, or helping patients stay out of the emergency department, Consumer Reports gives it a check mark.

Think of it as your health plan helping you hit the sweet spot: Getting the medical care you need, but not too much. After all, medical overtreatment not only drives health care spending higher, it also increases risks associated with medical tests and treatments, as Consumer Reports noted.

BCBSNC was one of three health plans in North Carolina to earn the avoiding overuse designation. Nationally, only 86 plans — or 17 percent — earned the check mark.

The $210 Billion Problem

Among the many drivers of health spending, overtreatment is drawing more attention. The Institute of Medicine in 2011 issued a landmark report finding that up to $210 billion a year in medical spending is the result of too much treatment and too many tests.

Health care experts have begun looking at insurers to help trim this waste and thus make a dent in rising health care costs. Using data from the nonprofit National Committee for Quality Assurance, Consumer Reports evaluated health plans on five criteria deemed important for helping avoid overuse: Antibiotics, imaging, hospital readmissions, emergency department use, and invasive heart procedures.

Consumer Reports‘ overall health plan performance rankings — also based on NCQA data — gave BCBSNC an 82 out of a possible 100 points, placing it tied for the highest rankings in North Carolina.

‘It’s Time to Get Mad’

As for Consumer Reports‘ scrutiny of rising health costs, the magazine took a look at what’s driving medical spending and what consumers can — and should — be doing. The story, titled “It’s time to get mad about the outrageous cost of health care,” looks at a number of causes. Among them: Too much medical testing, high-priced specialty drugs like Sovaldi, and a fondness for the latest and greatest medical technology.

Consumers can help manage health costs by finding out the real cost of the treatment they’re about to undergo, and by choosing a health plan with a smaller network, the magazine advised.

BCBSNC members have access to a treatment cost estimator that identifies average pricing for many medical procedures at North Carolina hospitals and physician practices. The company also offers a variety of individual plans ranging from a broad network of providers to value plans with smaller networks.