The rigidness of managed care sometimes is baffling. Hard and fast rules often dominate policy, yet they can backfire when implemented.
To win back consumers will require creativity, flexibility and knowledge of patient preferences.
By connecting the dots, researchers at the University of Michigan came up with a good pricing idea at the recent Radiological Society of North America meeting. They found that while most pregnant women expect ultrasound tests, clinicians generally agree that routine cases don't require the $300 procedure. Despite the questionable medical need, many health plans pay for the procedure to avoid alienating patients.
Furthermore, the Michigan team found that more than 95% of pregnant women surveyed believe ultrasound was very important in ensuring the health of their babies. Nearly half -- 44% -- said they were willing to pay up to $200 for the exam.
Here's the idea: Health plans should pay for ultrasound as long as patients agree to contribute. For instance, women with problem pregnancies would be tested as needed with no cost to the patient. Women over 30 with routine pregnancies might get one ultrasound at no cost and copay half the cost of additional procedures. Younger women with routine pregnancies could have a 25% copayment for the first test and pay half for additional ultrasounds.
Coupled with education on the merits of ultrasound, the copayments could help diminish demand for the test with minimal resistance from patients.
For providers and health plans, this presents a far bigger picture than the tiny fetus produced on the ultrasound film. Determining coverage limitations solely on clinical statistics can backfire. Offering options to patients based on research about their willingness to contribute can help ease the sting of managed care.