Personalized Healthcare for Patients Access to Price Transparency

摘要

We created an intelligent system that can accurately predict the price of an elective health care expense before the service is given. A database of paid health care claims is used to determine the price paid for elective services for each provider and insurance product. This is a difficult and important problem because the same service at the same provider can be a different price for people with different types of insurance, and the same service for a person with a given type of insurance can be a different price at different providers. The tool has been in use by Capital District Physicians' Health Plan, Inc. (CDPHP) employees since August 2016, and it is part of a service called CDPHP Price Check, where customer care specialists work with this augmented intelligence system to educate members about health care prices. A review of actual costs for 18 people who got the price estimates and then followed through to get the service showed that the estimates were usually within 2 percent of the actual price paid. In September 2017, it was made available for use by 35,000 high deductible plan members.