Providing Transparent Health Care Information to Consumers

Abstract

Systems and methods are described for providing consumers with access to the discounted rates for health care procedures provided by primary care physicians, specialist physicians and facilities. Fee information for contracted providers is stored in a database and is accessible to consumers via an online interface. Consumers select query criteria for providers and are presented with actual cost information pertaining to procedures prospectively rendered by providers. Additional information, such as quality or efficiency of providers, can also be presented. Information on multiple providers can be obtained and presented in a comparative arrangement. The presented information can be limited to providers within a geographic region, within a cost range, within a quality range, or other criteria.

What is claimed is: 
     
         1 . A method for displaying cost information and quality information in a user interface prior to a health care provider performing a health service, the method comprising:
 receiving a selection of a first health care provider that has a contractual relationship with a health plan organization, wherein the contractual relationship specifies a first monetary amount that the first health care provider would charge for performing the health service and/or a second monetary amount that the first health care provider would be compensated by the health plan organization for performing the health service;   displaying, via an electronic user interface, cost information for performing the health service, wherein the cost information is based on the first monetary amount and/or the second monetary amount under the contractual relationship; and   displaying, via the electronic user interface, quality information for the first health care provider, wherein the quality information includes indicia for at least one of: compliance of the first health care provider with predetermined quality criteria, a frequency of adverse reactions in past patients of the first health care provider, rates that past patients of the first health care provider subsequently have sought similar health care services, datedness of procedures used by the first health care provider, and comparison of the indicia to industry standards;   wherein the cost information and the quality information are displayed on the electronic user interface prior to the first health care provider performing the health service.   
     
     
         2 . The method of  claim 1 , further comprising:
 receiving, via the electronic user interface, consumer identity information; and   determining, via a health care computer system, that the consumer identity information corresponds to a member of a health insurance plan provided by the health plan organization.   
     
     
         3 . The method of  claim 1 , further comprising:
 displaying, via the electronic user interface, treatment cost efficiency metric for the first health care provider, wherein the treatment cost efficiency metric is presented to the consumer prior to the first health care provider performing the health service.   
     
     
         4 . The method of  claim 3 , wherein the treatment cost efficiency metric for the first health care provider is based on a total cost of treatment of at least one health condition, wherein determining the treatment cost efficiency metric comprises:
 grouping health insurance plan claim data for the first health care provider into an episode treatment group based on at least one of procedure codes and diagnosis codes associated with the claim data for the first health care provider;   associating the claim data in the episode treatment group with the at least one health condition;   aggregating costs for the claim data within the episode treatment group for measuring the total cost of treatment from the first health care provider of the at least one health condition; and   calculating the treatment cost efficiency metric for the first health care provider as a percentile ranking among a plurality of health care providers of the total cost of treatment of the at least one health condition.   
     
     
         5 . The method of  claim 1 ,
 wherein the health plan organization enters a contractual relationship with a second health care provider that specifies a third monetary amount that the second health care provider would charge for performing the health service and/or a fourth monetary amount that the second health care provider would be compensated by the health plan organization for performing the health service; and   wherein displaying the cost information further comprises displaying the third monetary amount and/or the fourth monetary amount prior to the second health care provider performing the health service.   
     
     
         6 . The method of  claim 5 , wherein the first and second monetary amounts corresponding to the first health care provider are presented in a comparative arrangement relative to the third and fourth monetary amounts corresponding to the second health care provider. 
     
     
         7 . The method of  claim 5 , wherein the first and second health care providers are within a specified geographic proximity to the consumer. 
     
     
         8 . The method of  claim 1 ,
 wherein the health plan organization enters a plurality of contractual relationships with a plurality of health care providers to compensate the providers in predetermined monetary amounts for performing the health service, each provider in the plurality being located within a specified geographic proximity; and   wherein the cost information further comprises a mathematical function of the predetermined monetary amounts.   
     
     
         9 . The method of  claim 1 , wherein the contractual relationship corresponds to a health plan provided by the health plan organization, wherein the health plan is a consumer-directed health plan. 
     
     
         10 . The method of  claim 9 , wherein the health plan is a high deductible health plan. 
     
     
         11 . The method of  claim 1 , further comprising:
 displaying, via the electronic user interface, a list of health services determined to be provided with high frequency by the first health care provider.   
     
     
         12 . A computing device for presenting cost information and quality information to a consumer, the computing device comprising:
 an input interface for receiving a selection of a first health care provider that has a contractual relationship with a health plan organization, wherein the contractual relationship specifies a first monetary amount that the first health care provider would charge for performing the health service and/or a second monetary amount that the first health care provider would be compensated by the health plan organization for performing the health service; and   a display device configured to:
 display, via an electronic user interface, cost information for performing the health service, wherein the cost information is based on the first monetary amount and/or the second monetary amount under the contractual relationship, and 
 display, via the electronic user interface, quality information for the first health care provider, wherein the quality information includes indicia for at least one of: compliance of the first health care provider with predetermined quality criteria, a frequency of adverse reactions in past patients of the first health care provider, rates that past patients of the first health care provider subsequently have sought similar health care services, datedness of procedures used by the first health care provider, and comparison of the indicia to industry standards; 
   wherein the cost information and the quality information are displayed on the electronic user interface prior to the first health care provider performing the health service.   
     
     
         13 . The computing device of  claim 12 , wherein the computing device is configured to receive consumer identity information and determine that the consumer identity information corresponds to a member of a health insurance plan provided by the health plan organization. 
     
     
         14 . The computing device of  claim 12 , wherein the display device is further configured to:
 display, via the electronic user interface, treatment cost efficiency metric for the first health care provider, wherein the treatment cost efficiency metric is presented to the consumer prior to the first health care provider performing the health service.   
     
     
         15 . The computing device of  claim 14 , wherein the treatment cost efficiency metric for the first health care provider is based on a total cost of treatment of at least one health condition, wherein determining the treatment cost efficiency metric comprises:
 grouping health insurance plan claim data for the first health care provider into an episode treatment group based on at least one of procedure codes and diagnosis codes associated with the claim data for the first health care provider;   associating the claim data in the episode treatment group with the at least one health condition;   aggregating costs for the claim data within the episode treatment group for measuring the total cost of treatment from the first health care provider of the at least one health condition; and   calculating the treatment cost efficiency metric for the first health care provider as a percentile ranking among a plurality of health care providers of the total cost of treatment of the at least one health condition.   
     
     
         16 . The computing device of  claim 12 ,
 wherein a second health care provider enters a contractual relationship with the health plan organization that specifies a third monetary amount that the second health care provider would charge for performing the health service and/or a fourth monetary amount that the second health care provider would be compensated by the health plan organization for performing the health service; and   wherein the display device is further configured to display the third monetary amount and/or the fourth monetary amount prior to the second health care provider performing the health service.   
     
     
         17 . The computing device of  claim 16 , wherein the first and second monetary amounts corresponding to the first health care provider are presented in a comparative arrangement relative to the third and fourth monetary amounts corresponding to the second health care provider. 
     
     
         18 . The computing device of  claim 12 ,
 wherein the health plan organization enters a plurality of contractual relationships with a plurality of health care providers to compensate the providers in predetermined monetary amounts for performing the health service, each provider in the plurality being located within a specified geographic proximity; and   wherein the cost information further comprises a mathematical function of the predetermined monetary amounts.   
     
     
         19 . The computing device of  claim 12 , wherein the display device is further configured to display, via the electronic user interface, a list of health services determined to be provided with high frequency by the first health care provider. 
     
     
         20 . A system for presenting cost information and quality information to a consumer, the system comprising:
 a health plan organization computer system; and   a consumer computer system configured to:
 receive a selection of a first health care provider that has a contractual relationship with a health plan organization, wherein the contractual relationship specifies a first monetary amount that the first health care provider would charge for performing the health service and/or a second monetary amount that the first health care provider would be compensated by the health plan organization for performing the health service; and 
 communicate with the health plan organization computer system in order to display, via an electronic user interface, cost information for performing the health service, wherein the cost information is based on the first monetary amount and/or the second monetary amount under the contractual relationship, and 
 communicate with the health plan organization computer system in order to display, via the electronic user interface, quality information for the first health care provider, wherein the quality information includes indicia for at least one of: compliance of the first health care provider with predetermined quality criteria, a frequency of adverse reactions in past patients of the first health care provider, rates that past patients of the first health care provider subsequently have sought similar health care services, datedness of procedures used by the first health care provider, and comparison of the indicia to industry standards; 
   wherein the cost information and the quality information are displayed on the electronic user interface prior to the first health care provider performing the health service.