FAIR Health Expands Total Treatment Cost Benchmarks

FAIR Health has expanded FH® Total Treatment Cost. Benchmarks for more than 20 diagnostic conditions and procedures have been added to this module, bringing the total to more than 40. For each condition or procedure, FH Total Treatment Cost provides a window into total costs for professional and facility services.

Treating chronic conditions like type 2 diabetes can involve a number of different services, supplies, tests and physician-administered medications. FH Total Treatment Cost provides estimates of the typical costs for all components of caring for chronic conditions (like asthma), event-based procedures (like a knee replacement) and acute conditions (such as pregnancy). The module offers cost and frequency information based on claims for the full range of procedures related to and typically performed in the common course of treatment for the included conditions. This tool provides a clear view of itemized and total billed amounts for affiliated treatments and estimated allowed amounts that are typically paid to in-network providers. It also includes the most common frequencies for each of the related services that occur in conjunction with these conditions.

FH Total Treatment Cost covers the patient’s beginning-to-end treatment path, including, as relevant, multiple office visits, professional and facility care, follow-up visits, lab testing, radiology services, physical therapy, equipment, specialty drugs and other related procedures and services. In the case of chronic conditions, a year of care is covered; for event-based and acute conditions, the time frame may be as short as a few days and up to nine months.

FH Total Treatment Cost has many applications. It can be used to:

  • Inform negotiations between providers and insurers;
  • Advance decision making;
  • Conduct internal analyses;
  • Customize reports;
  • Compare an organization’s experience to that of the overall market;
  • Communicate costs to consumers to increase transparency; and
  • Help with pricing value-based reimbursement models.

FH Total Treatment Cost is available in multiple formats:

  • An easy-to-use interactive application, allowing the user to select a condition and view related costs for all services that are typically associated with the condition. Data can be viewed and downloaded to Excel reports.
  • Flat file formats that can be loaded to your internal systems.

The benchmarks are grouped into 493 geozips—geographic areas typically based on the first three digits of a zip code—allowing national and local comparisons. The data are current, based on a recent 12-month window of claims and refreshed twice a year. The source of the data is our vast database, the largest repository of private healthcare claims in the country.

FAIR Health President Robin Gelburd stated: “FAIR Health endeavors to make its products as useful as possible to its clients. Now with more conditions and procedures than ever, FH Total Treatment Cost offers users a full picture of total costs of care for the most common medical treatments.”

For more information on FH Total Treatment Cost, contact FAIR Health by email at info@fairhealth.org or call 855-301-3247, Monday through Friday, 9 am to 6 pm ET.