MN Community Measurement publishes cost and quality information together to help consumers make informed decisions about their health care

In a significant step toward bringing cost and quality information together to help consumers make informed decisions about their health care, MN Community Measurement has published new information about how much medical groups are paid to provide more than 100 common health care services. MN Community Measurement, a nonprofit organization, already provides objective information on the quality of health care through its Web site, www.mnhealthscores.org.

MN Community Measurement worked with health plans and provider organizations to develop this measure based on a request from Governor Tim Pawlenty's Health Cabinet. "This has been a great example of how we can work together as a community to give people information they can use about the cost of care," said Jim Chase, president of MN Community Measurement.

A piece of the puzzle

The new cost-of-care measure reports the average amount health plans in Minnesota pay physicians and other health care providers to perform 103 health care services, including flu shots, colonoscopies and Cesarean sections. The measure does not include payments to hospitals and other health care facilities for services provided in those settings.

Four health plans in Minnesota provided the data for this measure: Blue Cross Blue Shield of Minnesota, HealthPartners, Medica and PreferredOne. The measure includes amounts the health plans paid in 2008 for people who received their insurance coverage through their employers, but not for people enrolled in a government program such as Medicare or MinnesotaCare. The data does not give consumers information about how much they will have to pay in copayments for the services. Consumers must consult with their health plans for that information.

The data reveals a wide range of payments for some services. For example, physicians are paid between $325 and $1,354 for their services in conducting colonoscopies, and between $29 and $236 for conducting group psychotherapy sessions.

"Rising health care costs have to be addressed if we're going to achieve a sustainable health care system that we can afford now and ten years from now. There are many factors that go into rising health care costs, including the number of services we use and the price we pay for them. This payment information is only a small part of it, but we think it is useful for consumers to see that there is a range in what health care providers are paid," said Chase. "They can use this information, along with quality information, their relationships with their caregivers, convenience and other factors to assess the overall value of the care they are receiving."

The amount that providers are paid is the result of negotiations between medical groups and health plans. Many factors influence the amount, including the size of the medical group, the cost of doing business in that region of the state, the number of uninsured or underfunded patients seen by the medical group, the amount of medical education and training provided by the group, the degree to which the group has invested in new technology or additional staff to improve patient care, and the types of patients the medical group sees. "It's complex," said Chase, "but we think it's important for this information to be available not just to the health plans and the health care providers, but to consumers as well."