1. COST CONTAINMENT INITIATIVE Dining Associates Day August 2013

2. NH Provider pricing variation (billed charge) ServiceProvider Price AProvider Price BProvider Price C Normal delivery$12,565 (WDH)$16,313 (Portsmouth)$17,525 (Exeter) Office visit (age 50-65) $86 (Portsmouth Family Practice) $116 (Mill Pond Family Practice) $167 (Dover Internal Medicine) Emergency room visit, minor $204 (Exeter)$552 (WDH)$772 (Frisbie) Mammography$483 (Women’s Life Imaging) $519 (Portsmouth)$766 (WDH) Hernia repair, OP$10,545 (Exeter)$15,537 (WDH)$17,784 (Portsmouth) MRI, knee, OP$1,916 (Exeter)$3,600 (WDH)$3,808 (Portsmouth) NH Insurance Dept. Data based on patient experience between December 1, 2010 through February 29, 2012 Dining Associates Day August 2013

3. Cost Containment Nationally Hip replacement for 62-year old woman ranged from $11,000- $126,000 and 15% of the 122 hospitals contacted were unable to provide a cost estimate at all (JAMA Internal Medicine, 2/11/13) In Saint Augustine, Fla., one hospital typically billed nearly $40,000 to remove a gallbladder using minimally invasive surgery, while one in Orange Park, Fla., charged $91,000 (New York Times, 5/8/13). In New York, a patient spent three days in White Plains Hospital after a food poisoning outbreak that sickened more than 100 people. Thanks to insurance coverage by United HealthCare she owed only $8.00. Still, she was baffled by the charges: $6,844, including $546 for six liters of saline that cost the hospital $5.16 (New York Times, 8/25/13). Dining Associates Day August 2013

4. 1.When you are in need of medical care, know where to go: try the UNH Employee Clinic 2.Ask if a generic prescription is right for you 3.HPHC members participate in the Tandem Care Health Shopping Program 4.Do your research 5.Ask questions What can you do? Dining Associates Day August 2013

5. http://www.kaiserhealthnews.org/stories/2013/may/19/with-high-deductible-plans-it-pays-to-shop-around-for- care.aspx

6. http://www.nhhealthcost.org/costByProcedure.aspx Dining Associates Day August 2013

7. HospitalAccess Plus The following hospitals offer a 15% discount to patients without insurance: Concord Hospital Dartmouth-Hitchcock Medical Center Elliot Hospital Exeter Hospital Frisbie Memorial Hospital Portsmouth Regional Hospital Wentworth Douglass Hospital http://www.nhha.org/for-patients/hospitalaccessplus Dining Associates Day August 2013

8. Hospital billing error vastly overcharges NH woman Portsmouth Herald, October 09, 2011 A New Hampshire woman just couldn’t believe the nearly $2,000 bill she received for a bottle of antibiotic pills was right, so she persisted in demanding answers. In the end, it turned out that Susan Chamberlin should have been charged $382.50 by Portsmouth Regional Hospital. Chamberlain says she was shocked when she first got the $1,912.50 bill for a bottle of cefuroxime pills given to her daughter during emergency treatment. Dining Associates Day August 2013

10. Ask for Generic Substitution Dining Associates Day August 2013 Brand NameCost Per Day/Month GenericCost Per Day/Month Zocor (cholesterol) $4.97/$149.02Simvastatin$0.15/$4.50 Nexium (heartburn) $6.89/$206.70*Omeprazole (generic Prilosec) $0.34/$10.16 Effexor XR (depression) $6.12/$183.49Venlafaxine$1.33/$39.94 Fortamet (diabetes) $19.92/$597.53Metformin XR$0.23/$6.81

11. American Board of Internal Medicine http://www.choosingwisely.org Created a list of medical tests and treatments you may not need: Antibiotics for a sinus infection A stress test with no sign of heart disease Imaging for lower back pain Antibiotics for pink eye PET or CT scans for cancer in healthy people Imaging for uncomplicated headache Pre-operative chest x-rays for patients with unremarkable history Dining Associates Day August 2013

12. When to call Tandem Care  When your doctor schedules you for: MRI CT Scan Mammogram Ultrasound Colonoscopy Outpatient surgery Lab tests Other outpatient tests and procedures  These are just examples. You can call about any outpatient test or procedure ordered by your doctor.  Be sure to call before your appointment so Tandem will have time to reschedule with the low cost provider you choose. Dining Associates Day August 2013

13. Tandem Savings Examples ServiceOrdering ProviderLower Cost ProviderDifferenceTandem Reward Physical TherapyDover: $1,400Dover, free-standing facility: $800 $600$100 ColonoscopyExeter: $2,339Stratham, free standing facility: $705 $1,634$200 Colonoscopy & Upper GI Endoscopy Rochester: $4,000Stratham, free standing facility: $2,300 $1,700$200 MRIDover: $3,553Portsmouth NH free standing facility: $632 $2,921$200 Lab testDover: $388UNH Employee Clinic: $94 $294$75 Lab testRochester: $652UNH Employee Clinic: $119 $534$100 X-rayDover: $297UNH Employee Clinic: $43 $254$75 Dining Associates Day August 2013

14. Does Lower Cost = Lower Quality? Dining Associates Day August 2013 Example: Leapfrog’s Highest scoring hospital in DC is Sibley Memorial, which earned an “A” yet lists charges of about half of the highest-priced hospitals in the region.

15. Be a smart health care shopper. When your doctor schedules you for an outpatient test or procedure, call or email Tandem Care: 866-797-4100 Monday to Friday 8:30 to 5:00 (Eastern) info@tandemcare.com Online at www.tandemcare.com Save money. Earn cash rewards. The choice is yours. Dining Associates Day August 2013

16. Contact Information Amy Schwartz, MPH Project Director Amy.schwartz@unh.edu Office:603-862-5099 Mobile:603-502-4126 Dining Associates Day August 2013