Online tool allows Minnesota patients to weigh cost, perks

The founders of a consumer-driven health plan now owned by UnitedHealth Group are back with a concept they believe will further aid their goal of medical cost containment.

Carol, a Web site launched in January, allows consumers to plug in a specific health need, then see a list of prices and packages offered by various hospitals and physicians. The site, whose name the company says refers to an idealized relative or friend, also has consumer ratings of hospitals and doctors (link).

Some analysts have compared Carol to online travel sites that allow users to see fees and perks of various hotels and flights before booking. As it turned out, just weeks after Carol launched, Dept. of Health and Human Service Secretary Michael Leavitt called for a "Travelocity-type" site where patients could compare prices and quality information. Leavitt's office confirmed that he did not know about Carol's launch at the time of that speech but did not respond to requests to comment on the site.

Carol's founders include Tony Miller, co-founder and former chief executive officer of Definity Health, one of the first companies to offer consumer-driven health plans such as health savings accounts. United bought Definity, its fellow Minneapolis-area company, in December 2004. Miller then formed Lemhi Ventures, which put $25 million into the startup of Carol. For now, Carol's reach extends only to the Minneapolis-St. Paul vicinity, though the company says talks are under way with physicians and hospitals in Seattle and Cincinnati to offer services there.

Robert K. Meiches, MD, chief executive officer of the Minnesota Medical Assn., said he likes parts of the Carol concept but believes it's not practical in some situations.

For elective surgeries such as hip replacements or for patients in pain who are seeking diagnostic tests, Carol "could be useful," Dr. Meiches said. But he added that people still need to confer with their primary care physicians in such matters. "Their medical home can help them navigate the system" and find the best physician for each situation, he said.

Meanwhile, some experts say that although Carol is a helpful tool for those in consumer-driven health plans, the number of people in those types of plans is still relatively low. A study published last spring by the National Business Group on Health and Watson Wyatt Worldwide found that 38% of employers were offering consumer-driven health plans, but enrollment was only at 8%, just one point higher than the previous year.

"Getting more information to people is useful for policies with high cost-sharing," said Martin S. Gaynor, PhD, professor of economics and public policy at the H. John Heinz III School of Public Policy and Management at Carnegie Mellon University in Pittsburgh. But for the majority of people who are still in employer-sponsored plans, this information won't matter that much to them, he said.

How it works

Also involved with Carol is former Definity chief medical officer Tom Valdivia, MD. Dr. Valdivia, Carol's president, said that on the site, consumers can get a precise accounting of what they will get for their money while giving doctors a chance to "tell their stories."

"When consumers are going on [the site], the most important thing they learn ... isn't price. Third is price," Dr. Valdivia said. The top concern, he said, is "what are the features of the care I will get."

For example, when comparing packages for an MRI of the knee, one package includes snacks and beverages during the wait, scrubs (no gowns), a private changing area and the promise of results within 24 hours given by a musculoskeletal radiologist, all for $875. Another package, priced at $1,000, gives a very brief description, which includes results in one or two days and mentions nothing about the accommodations or perks that the other package offers.

Marcus Thygeson, MD, medical director and vice president for consumer health solutions at Health Partners, a Minnesota-based network that operates 70 medical and dental facilities as well as a health plan, said his organization's involvement with Carol has resulted in more creative thinking on the part of the physicians. When doctors create the care packages, it makes them really think about the quality of care they give and how they deliver it, he said.

If a patient's insurer is partnered with Carol, the member can find out what the out-of-pocket expenses are before the appointment, Dr. Valdivia said. Definity and other Minnesota-centered insurers, including Health Partners, are allied with Carol, but no national plan such as WellPoint or Cigna has signed up. United's presence is limited to its Definity unit.

Carol says that its ratings, geared specifically toward the care packages, are reviewed and vetted by an internal team that includes a physician, company spokesman Jim Poulter said.

But Dr. Gaynor said he doesn't see how Carol's rating system can be objective when each patient could have a different view of what constitutes quality care.

Dr. Meiches said the Minnesota Medical Assn. is in favor of getting information on quality and price out to members but added that there are many variables that go into determining quality. The medical society has been meeting with Carol to determine the best ways to go about this.

MMA fought Blue Cross Blue Shield of Minnesota last year when it launched an unfiltered physician rating site that allowed anyone to post information about doctors. The Blues plan later agreed to monitor comments to ensure that posters actually had seen the doctors they were posting about.