Choosing the right place for care can save time, stress and money

PRESIDENT OF ANTHEM BLUE CROSS AND BLUE SHIELD IN NEW HAMPSHIRE

The Rising Importance of Choice

Many people have experienced it: an unexpected illness or injury disrupts the day, or routine bloodwork gets pushed further down the to-do list.

Today, people have more choices than ever for receiving routine care, from virtual care and urgent care to retail clinics and ambulatory surgery centers. But where people receive care can significantly affect both costs and the overall experience.

For routine or non-emergency care – such as diagnostic imaging, lab work, infusions, and procedures that do not require an overnight hospital stay – people typically have two categories of choice:

• Non-hospital settings such as their primary care doctor, urgent care clinic, ambulatory surgery centers, or virtual care; and

• Hospital-based outpatient settings, where people receive care without being admitted overnight.

For example, virtual care may be a convenient option for flu-like symptoms, allergies, rashes, or sinus infections, while urgent care may be more appropriate for sprains, ear pain, or minor injuries.

But different care settings come with different price tags. For example, research consistently shows that hospital outpatient departments charge more, in part, due to facility fees, even when the quality of care is the same. A recent study found that infusion care received in hospital outpatient departments resulted in 42% higher costs than care provided in non-hospital settings, despite similar outcomes and patient experience. In many cases, people can receive the same high-quality care in lower-cost settings, without sacrificing outcomes or convenience.

The challenge is that these cost differences can be hard to anticipate. While the emergency room may seem like a good choice for last-minute care needs, it typically costs more and takes longer than other non-emergency care options.

That is why helping people understand their options and identifying high-quality, lower-cost alternatives is a core focus for Anthem. Through plan design, care-navigation tools, and support, Anthem enables members in New Hampshire to compare care locations, understand potential cost differences, and explore lower-cost, high-quality alternatives when clinically appropriate.

We are proud that Anthem was the first insurer in New Hampshire to bring “Site of Service” plan designs and the “Smartshopper” rewards program to employers and their employees. Members find the information they need about how to take advantage of these offerings on our Sydney Health app – enabling them to better consider the cost of the care they need.

Why It Matters: Cost and Care Experience

Care settings outside the hospital may offer more convenient experiences, including shorter wait times, easier scheduling, and care closer to home. Plus, there are typically no hidden facility fees.

One non-hospital option that may be less known to people is ambulatory surgery centers. These centers can perform many of the same routine outpatient procedures as hospitals, such as colonoscopies or upper gastrointestinal (GI) procedures, but at a lower cost. In fact, people can save up to several thousand dollars per surgery when procedures are performed at an ambulatory surgery center. Not only can they save through their cost sharing when they are enrolled in a Site of Service-style plan, but they can also earn rewards through the Smartshopper program.

How Anthem Can Help

Helping people make informed decisions starts with providing clear information before care is received. Anthem offers tools and resources designed to help members understand their options, compare costs, and identify high-quality care settings that may lower out-of-pocket expenses.

Through the Sydney Health app and Anthem’s Find Care tool, members can locate in-network providers, compare care options, and access information that helps them make informed decisions before scheduling care.

Anthem’s Site of Service offerings referenced above also help connect eligible members with ambulatory surgery centers and other qualified facilities that can provide many outpatient procedures, imaging services, and laboratory tests in lower-cost settings when clinically appropriate. New Hampshire members have access to participating facilities throughout the state, helping make affordable care more accessible and convenient.

In addition, SmartShopper helps eligible members compare the cost of certain healthcare services and identify high-quality, cost-efficient providers. In some cases, members may earn a financial reward for choosing a lower-cost option.

Together, these resources help make healthcare easier to navigate while reducing the likelihood of unexpected costs.

Learn more at anthem.com/healthcareinnewhampshire.