Castlight’s problems are echoed elsewhere.
“You can’t save money if people aren’t shopping,” said Mitch Rothschild, the executive chairman of a competitor, Vitals. His company offers tools that let workers earn cash when they select a less expensive option for a service like an M.R.I.
“It’s a heavy lift,” he said. “It really requires behavioral change for most of America.”
People may not shop around for a variety of reasons. If they have an urgent medical need, for example, they may not have time to use the tools to decide which emergency room to visit or where to seek treatment for a heart attack. Much of their care may be more expensive than their plan’s deductible, making the price largely moot. In some markets, there may not be another specialist, or the prices may not vary much. And if the health plan wants its users to get care from a specific group of providers to coordinate care better, shopping may not make sense.
For these reasons, and others, a study from the Health Care Cost Institute, a nonprofit research group that studies health care costs, concluded this year that “the potential gains from the consumer price shopping aspect of price transparency efforts are modest.”
Castlight’s tools are available only to customers with direct access. It uses a mix of insurance claims and outside quality measures, like Consumer Reports rankings, to develop the price and quality comparisons it presents for those providers in an insurance plan’s networks. Employees can weigh in with their own satisfaction ratings.
As a result, the tools may be useful but may not encourage people to shop. Kristin Voyles, of Wagoner, Okla., says she and her husband appreciate that Castlight’s site shows all of their sizable medical claims in one place. (One of their children has a rare form of hemophilia.) That easy access helped when the family was preparing its taxes and needed the information to deduct medical expenses — offering a great alternative to the binders she and her husband had used to keep track of their medical bills.
“Once we figured out all of what it could do, it made life easier,” she said.
Since they know that their costs exceed their insurance plan’s deductible, Ms. Voyles said, they did not use Castlight to look at a doctor’s prices. Instead, they use it to try to validate the specialists recommended to them by other doctors.
While Castlight and other companies say they are committed to improving the quality ratings they assign to individual physicians and doctors, the lack of reliable measures makes it hard to use these tools to shop.
“It’s hard to make heads or tails out of all the quality information out there,” said Suzanne Delbanco, the executive director for the Catalyst for Payment Reform.
Companies like Castlight have shifted even more emphasis to employers, offering them the technological ability to sort through their claims to find ways to control costs. While Castlight says it has not abandoned its focus on helping employees make better choices, it has joined a growing number of companies offering employers ways of explaining benefits to their workers and identifying the sources of rising medical bills. Castlight says information about individual employees is never shared with the employer.
By sifting through medical claims, Castlight can try to identify people at a time when a recommendation might make a difference. Someone going to the doctor to seek help for back pain for the first time might be reminded that the plan covers physical therapy, for example, or someone about to get back surgery may get a suggestion to consider a second opinion.
While employers are “an important fuel for our business,” Mr. Doyle said, Castlight still wants to help people pick the provider that delivers high-quality care for the lowest cost.
“If we can’t do that,” he said, “at the end of the day, all of the complexity is for naught.”
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