BCBS chapter plays healthcare game right

WHAT IT MEANS AND WHY IT'S IMPORTANT The news that Anthem Blue Cross and Blue Shield in Virginia is developing tools to help members throughout the state easily access information on lower-cost emergency room alternatives -- like retail-based health clinics -- is just one more indicator that the physician shortage and soaring healthcare costs are taking a major toll on Americans.

(THE NEWS: Local Blue Cross Blue Shield offers ER alternatives to members. For the full story, click here)

Anthem stated that, based on a study of its claims data, average costs for visits for all conditions studied ranged from $441 for the ER to $98 for urgent care and $52 for retail clinics. These costs represent total costs, including the portion paid by the health plan member. There is undoubtedly a significant cost difference when seeking an ER alternative. In Virginia alone, there were more than three million total ER visits in 2008, according to Statehealthfacts.org.

Underscoring the fact that cost is a major factor in seeking medical care are the findings of Deloitte's "2010 Survey of Health Care Consumers: Key Findings, Strategic Implications." This survey, based on a national sample of 4,008 American adults between Dec. 28, 2009 and Jan. 5, 2010, found that 40% of consumers said they did not seek medical treatment either because of cost or insurance coverage, compared with 38% in 2009. Among the uninsured, cost (74%) is the main reason for delaying or forgoing treatment.

The military also is concerned about sufficient access to care for its U.S. members and is asking more healthcare professionals to become Tricare health benefit program providers.

The wars in Iraq and Afghanistan, among other factors, have put a significant strain on the military healthcare system, so the Department of Defense is issuing a call to expand the number of private-practice physicians and other healthcare providers to provide services to Tricare members. Tricare services 9.6 million active and retired military members and their dependents worldwide.

Clearly there is a need to help consumers easily locate convenient and affordable medical care and to communicate the message that there are often more favorable -- not to mention cheaper -- options than the ER. It also is clear that retail-based clinics are part of the solution.