The Pulse
4:27 pm
Fri January 10, 2014

Tools For Health Care Consumers: Quality, Cost, And Care

Thousands of Rhode Islanders have signed up for health insurance in recent weeks, some for the first time. I'm thinking that means some might not be so familiar with our health care system, or they might not know how to keep costs down with plans that carry higher deductibles or out-of-pocket costs.

So... here are a few tools to help you navigate, from finding the highest quality, to keeping costs down, to managing your own health. It's not an exhaustive list, but a start...if you're starting from scratch!

Quality: Medicare has had a tool that you lets you look up and compare hospitals based on certain quality measures for a while, but they just added a few new measures, including how timely and effective a hospital's stroke and pregnancy care are, as well as how well a hospital controls MRSA infections. Overall, Rhode Island hospitals fare a bit worse than national averages according to these measures. But it's important to look at more than just the overall rating; that doesn't tell the whole story. Some hospitals deal with sicker patients to begin with, so their readmission rates are often higher (and hospitals sometimes say the quality rankings are, therefore, too punitive). Still, if you have to have surgery or some other procedure, you might want to check out Medicare's Hospital Compare tool to see how your facility measures up.

Cost: Fair Health's "Consumer Cost Look Up" walks you through a few steps to come up with a cost estimate for a long list of medical procedures and services based on where you live. They also offer lots of other helpful tools and educational materials for understanding insurance (e.g., "Understanding your EOB" or "Out-of-network docs at in-network hospitals"). Healthcare Blue Book is also helpful in determining what its creators call a "fair price" for the procedure you're looking up, which includes things like ultrasounds and x-rays. Some insurance companies offer tools that let you estimate the cost of a medical service, like childbirth, on their web sites, as well.

Care: If you're not used to regular doctor visits, screenings, or checkups, visit healthfinder.gov, where you can learn which screening tests or vaccines you need and when, what questions to ask the doctor when you do visit, and more. There's also lots of information about particular diseases and conditions, how to live a healthy lifestyle, and even a tool that lets you plug in your age and sex to generate a personalized list of health recommendations (which tests you need, etc.). Of course, your best bet is always a conversation with your doctor. But I have yet to meet a doctor who doesn't encourage patients to take charge of their own health.

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