MyCare Advisor is our online suite of tools that assist Members in understanding and comparing cost, quality, and satisfaction among Providers.

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Transcription:

January 2012

What is MyCare Advisor SM? Thinking about health care services in a different light is the first step to educating yourself on health care costs. Capital BlueCross is taking the second step of providing you with relevant information. MyCare Advisor is our online suite of tools that assist Members in understanding and comparing cost, quality, and satisfaction among Providers. Our initial launch of the tool focuses on facility cost comparison, and provides cost ranges for many of the most common elective medical procedures and services. The MyCare Advisor tool can help a Member to estimate their out-of-pocket expenses related to a procedure or service, which is especially helpful for those Members who have a Qualified High Deductible Health Plan with an HSA. MyCare Advisor can also provide valuable insight when selecting where a procedure is performed, since all providers are not priced equally. GR-P11-275/2.PPT (5/5/2011) 2

MyCare Advisor Procedures MyCare Advisor provides cost ranges for many of the most common elective medical procedures and services. Inpatient Outpatient Diagnostic Office Visit Cardiac angioplasty with drug eluting stent Cardiac defibrillator implant without cardiac catheterization Coronary bypass (CABG) without cardiac catheterization C-section and vaginal delivery Knee and hip replacement Spinal fusion (anterior and posterior) Hysterectomy Back surgery ACL repair by arthroscopy Back surgery Bladder repair for incontinence (sling) Breast biopsy Breast lumpectomy Bunionectomy Carpal tunnel Typanostomy Cataract removal D and C Hammertoe correction Hernia repair Knee or shoulder arthroscopy Gall bladder removal Tubal block and tubal ligation Tonsillectomy and adenectomy Left heart catheterization Lithotripsy fragmenting of kidney stones Nasal/sinus corrective surgery septoplasty and endoscopy Upper GI endoscopy (w/ and w/o biopsy) Screening colonoscopy Colonoscopy w/ biopsy Bronchoscopy Urethra and bladder scope Analog mammography Digital mammography Bone density study of spine or pelvis CT scan (abdomen, head, pelvis) MRI (brain, upper/lower limb, spine) Chiropractic Well woman Physician care existing patient Physician care new patient Pediatric well visits GR-P11-275/3.PPT (5/5/2011) 3

MyCare Advisor New Procedures Effective January 2012, additional cost ranges for approximately 43 procedures were added. Inpatient Removal of plaque build-up in the major neck (Carotid) arteries Revision of hip or knee replacement Removal of Prostate gland and surrounding tissue Partial or total removal of Thyroid gland Outpatient Colonoscopy with removal of lesion Hysterectomy with removal of lesion or lining uterine tissue Uterine tissue sample (biopsy) Repair of Umbilical hernia, over age five Spinal fusion of neck anterior Bladder scope with stent Diagnostic CAT Scan of upper jaw (maxilla) and face CAT Scan of chest (thorax) CAT Scan lumbar spine (lower back) MRI Thoracic spine (mid back) Ultrasound exam of soft tissues in head and neck Ultrasound exam of breast(s) Ultrasound of abdomen Ultrasound of pelvis Bone scan of whole body PET Scan image from skull base to mid-thigh PET Scan image of whole body Office Visits - Vaccine Hepatitis A, adult Hepatitis B, adult Hepatitis A and Hepatitis B, adult Pneumococcal, adult Flu, over age three Tetanus, Diphtheria, and Pertussis (Tdap), over age seven Shingles (Zoster) Meningitis Human Papilloma Virus (HPV) Office Visits Initial interview for mental health evaluation Short mental health session with behavioral health specialist Short mental health session with Psychiatrist Moderate mental health session with behavioral health specialist Moderate mental health session with Psychiatrist Long mental health session with behavioral health specialist Long mental health session with Psychiatrist Family behavioral health session Group behavioral health session Behavioral health medication management Periodic well woman GYN exam and Pap smear age 18-39 Periodic well woman GYN exam and Pap smear, age 40-64 New patient well woman GYN exam and Pap smear, age 18-39 New patient well woman GYN exam and Pap smear, age 40-64 GR-P11-275/4.PPT (5/5/2011) 4

What Information is Displayed? Once you enter the ZIP code where the service will take place and select a procedure, all of the facilities that meet the criteria will be displayed. Cost ranges are displayed for each facility (acute care hospital, ambulatory surgical center, and imaging centers) and include all services from admission to discharge if applicable. Besides the cost range, you will also see: The name and contact information for each facility The network the facility is participating PPO The facility s Blue Distinction Centers (BDC) designation A BDC designation is awarded to facilities by the BlueCross BlueShield Association that demonstrate expertise in delivering quality health care The number of procedures performed annually at each facility GR-P11-275/5.PPT (5/5/2011) 5

Login to capbluecross.com GR-P11-275/6.PPT (5/5/2011) 6

mycapbluecross.com GR-P11-275/7.PPT (5/5/2011) 7

MyCare Advisor GR-P11-275/8.PPT (5/5/2011) 8

MyCare Advisor Enter search criteria Here s an example of a search for an MRI of the Lower Limb in the Reading area. GR-P11-275/9.PPT (5/5/2011) 9

MyCare Advisor Search Results GR-P11-275/10.PPT (5/5/2011) 10

MyCare Advisor Search Criteria Here s an example of a search for an Cardiac Angioplasty in the Reading area. GR-P11-275/11.PPT (5/5/2011) 11

MyCare Advisor Search Results GR-P11-275/12.PPT (5/5/2011) 12

MyCare Advisor Search Criteria Here s an example of a search for an Office visit in the Reading area. GR-P11-275/13.PPT (5/5/2011) 13

MyCare Advisor Search Results GR-P11-275/14.PPT (5/5/2011) 14

Future Enhancements Incorporate national facility quality data (i.e. CMS, Leapfrog, HCAHPS) Create mobile application Add phone number for facilities Create a map it feature for facilities to provide Members with directions Add sort functionality (i.e. by # of procedures, cost) GR-P11-275/15.PPT GR-PT-32/15.PPT (7/25/2011) (5/5/2011) 15

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