Online Tools to Shop for Doctors Snag on Health Care’s Complexity

Need a dermatologist? Today, online tools can show you which doctors are in your plan’s network as well as rank them by the likely cost of a visit.

Still not sure which one to pick? The tools also show whether you have already met your plan’s deductible and offer Yelp-like reviews of the doctors.

The idea behind these web tools, which have been available from health insurers and start-ups for several years, is to harness the power of so-called big data. The companies cull medical claims and other sources of information to help people become sophisticated shoppers for medical care — and they promise to curb the overall cost of health care in the process. By some estimates, the savings from this newfound transparency could run in the billions of dollars a year.

Yet the limits of this data are becoming increasingly clear. Even when people have access to the newly available information, they may not use it. And when they do, they may not rely on the insight. It is impossible to know, for example, whether a dermatologist who costs twice as much as another can more successfully diagnose skin cancer.

“Price transparency tools are not likely the panacea that many have hoped for with respect to controlling health care costs,” Dr. Kevin Volpp, the director of the Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute, wrote in an editorial for The Journal of the American Medical Association. The editorial ran with a study of two large employers that found no decrease in outpatient spending as a result of workers’ use of online transparency tools.

This data’s limits are exemplified by Castlight Health, a San Francisco technology company and an early proponent of price transparency.

Castlight, which started eight years ago, ignored the resistance from health insurance companies, hospitals and doctors to make the prices they negotiated available. Castlight told employers it would help their workers make better medical decisions by giving them better information.

When it went public in 2014, it earned a valuation of about $3 billion. Today, Castlight’s stock has fallen nearly 90 percent as it has found that changing how people pick doctors and hospitals is much harder than expected. Obtaining prices and other crucial information has proved difficult, and trying to engage employees when they are deciding where to go and what care they need has been daunting for everyone in the industry. And many fewer people are shopping than employers had hoped.

Castlight executives insist is it still very early. “We overestimated the speed here,” said Dr. Giovanni Colella, the company’s chief executive and one of its founders.

“Transparency hasn’t even started,” he said.

Castlight says its tools continue to evolve, and some of its customers say their employees are using the tools to save money on labs or to steer them to certain providers.

Castlight executives insist that a huge unmet demand remains. “We are many years from the ideal, but the reality is if you’re a patient today and going to be prescribed an M.R.I., the default is a situation where you roll the dice,” said John Doyle, Castlight’s chief operating officer.

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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