Website may spark change in medical economics

They picked the name Carol for its retro ring, like leaning over the back fence to get advice from a neighbor. But Carol.com's ambitions are entirely futuristic.

Its creators want to do for health care what Travelocity did for airline tickets.

Ankle pain? Click on the matching body part and two options pop up. For $199, doctors at Sports and Orthopaedic Specialists will check out your ankle, review your medical history and recommend treatment. TRIA Orthopaedic Center lists a similar package for $213 -- and a reminder that they are the team doctors for the Vikings and Timberwolves. What did patients think? Read user reviews. Will your health plan pay? Tap in your details and find out.

Plymouth-based Carol.com, which debuted this month, is the first attempt in the country to put those pieces together in an online medical marketplace. In doing that, Carol's creators are riding the leading edge of a wave of change headed toward consumers just as questions about how to cure the nation's chronic health care crisis are resounding from the corner cafe to the presidential campaign trail.

Some think putting more choices in consumers' hands will drive down spiraling health care costs. Others fear those choices may be too complex for the average person to make. This occasional series aims to help you prepare for the potential benefits and risks in solutions being considered -- and sometimes already launched -- by insurers, providers, government and entrepreneurs such as Carol.com. It's been two decades since employers began a similarly seismic shift from pensions to 401(k) investment plans. Now, after struggling for years with shouldering medical costs that outstripped inflation, many employers would like a 401(k)-style setup for health care. They would contribute money, but employees would be responsible for spending the dollars and investing in healthy behavior.

That would create a clamor for information on prices, services, doctors and hospitals.

For now, the Carol site remains a work in progress with a limited number of services. But if it takes off, supporters say, Carol and the copycats it inspires could profoundly affect how Americans buy health care. That's why it's being watched by Harvard researchers, Washington think tanks and health care reformers across the country.

"We need to move in this direction," said Paul Ginsburg, president of the Center for Studying Health System Change in Washington. If Carol succeeds in the Twin Cities, Ginsburg said, "it should work in a lot of other places."

Some providers are plunging in. Others are dipping a toe. HealthPartners put 100 employees to work describing and pricing more than 60 packages on Carol. Mayo Clinic has posted just one -- for pregnancy counseling. The Twin Cities' two biggest chains, Allina and Fairview, have yet to join.

The biggest buy-in will have to come from consumers themselves. Most Americans with insurance have high expectations for the care they're entitled to, cost be damned. Are they ready to make the mind-shift to shopping for care and living a healthier lifestyle to reduce costs in the long term? As employers continue to pare benefits, they may not have a choice.

How did we get here?

In the past, most patients cared about just two numbers: monthly premiums and the co-pays they forked out for a doctor visit.

Critics say this has helped fuel medical inflation, with medical costs now consuming a whopping 16 percent of the economy -- far more than in other developed nations.

The Bush administration wants to moderate costs with health savings accounts, where consumers stash tax-deferred funds for medical expenses. These are paired with high-deductible, low-premium plans. The hope is that patients will take the money saved on premiums, park it in those accounts and make wise spending decisions on the first $2,000 or $5,000.

It's too early to say whether these newfangled plans lead to better health or lower costs, but many employers aren't waiting. This year, 9.5 million Americans have health savings accounts and their cousin, health reimbursement accounts, according to the Consumer Driven Market Report in Washington. That's expected to rise to 13 million next year. (Health savings accounts are portable between employers while health reimbursement accounts are not.)

In addition, many health plans now also come with co-insurance, with members liable for 10 or 20 percent of a certain portion of medical bills.

The shift is likely to continue no matter who moves into the White House next January. Top Republican presidential candidates support expanding health savings accounts. The leading Democratic candidates focus more on expanding coverage for the uninsured, but also call for better consumer information on price and quality.

Blue Cross & Blue Shield of Minnesota last year launched HealthcareScoop.com for patients to post reviews of doctors and hospitals. Medica offered Mainstreetmedica.com, listing price ranges for procedures. State law now compels insurers and hospitals to give price estimates if asked.

But when it comes to finding out the exact price for any one patient, it still takes an e-mail or a phone call to that person's health plan and usually a day's wait for an answer.

"Consumers are being asked to do a lot more," said Mary Brainerd, chief executive of HealthPartners. "But the tools aren't necessarily up to the task yet."

Whether health organizations attempt their own websites or join Carol depends on whether they think it can be "like Hotels.com," said Stephen Parente, health economist at the University of Minnesota's Carlson School of Business, "where you can't afford in the hospitality business not to get online."

Launching Carol.com

Thirty "tenants" have "rented space" on the site, paying a monthly fee of between several hundred and thousands of dollars. They'll pay another small fee if someone makes a transaction. But there are still too few "care packages" online -- just 350 spread over 190 categories. Someone looking for a brain CT scan would find just one listed by the Center for Diagnostic Imaging, for $460.

Dr. Tom Valdivia, head of business development, wonders aloud if Carol should list all facilities, whether or not they've signed on. For that, retorts Carol's pugnacious chief executive Tony Miller, "I can get the phone book."

A former consultant for Deloitte & Touche, Miller, 41, and others started Definity Health in 1999, introducing the first health reimbursement and savings accounts. In 2004, UnitedHealth Group bought Definity for $300 million and every big insurer in the state now offers similar plans. Miller went on to set up Lemhi Ventures, which has some UnitedHealth money. Carol has gotten $22 million from Lemhi so far.

For Miller, Carol is the culmination of those efforts. "Consumers will reinvent the way care is bought," he said.

No one thinks this will be easy. "It's such a mammoth venture," said Regina Herzlinger, a Harvard Business School professor and author of "Who Killed Health Care?" She has known Miller since his Definity days. "If anybody can do it," she said, "Tony can."

Carol's fate lies with people such as Lisa Hashbarger.

A 34-year-old mother of two in Minneapolis, Hashbarger has a Definity plan through her husband's job. His employer contributes $1,500 to their $3,000 deductible. The Hashbargers also are responsible for 10 percent of the next $5,000 in medical bills. Anything after that is fully covered.

Hashbarger is an avid online shopper who says she "hyperanalyzes" each purchase. That's why she's one of 900 test users recruited by Carol. Recently her 2-year-old son fell and chipped a tooth; she found a dentist using Carol.

Others have tried -- and failed -- to do pieces of what Carol is attempting. Start-up firms from the early 2000s -- such as Vivius, which tried to let members create their own doctor and hospital networks -- folded or were bought by big insurers.

Carol's timing is better, said Dr. Lee Newcomer, the founder of Vivius who now chairs the board at Park Nicollet Health Services and is a senior executive at UnitedHealth. People are more used to Internet shopping and sick of rising medical bills.

"If you go to a restaurant and say I want a salad and a dessert, you can do that," said Dr. Peter Dehnel, chief of staff at Children's Hospitals and Clinics of Minnesota. "If you want rheumatoid health services and you say 'this is all you can do, doctor or nurse, I'm not going to pay for anything else ...[that's] going to have bad outcomes. The rules of consumer choice no longer apply."

Early impact

There are early signs that Carol is having some effect.

Alarmed at how its price for treating a sinus infection ($231) stacks up next to MinuteClinic's ($49), Park Nicollet is trying to figure out how to bring that down, perhaps using nurses instead of doctors to treat simple ailments.

"As a result of Carol, we will restate that payment," said chief executive David Wessner. "We think this is good for health care."

That's what Dr. Lee Beecher has been trying in his St. Louis Park psychiatric practice. He signed on to Carol to get his solo practice on the same footing as big providers.

It forced Beecher to ask himself: What did he do, exactly? He ordered tests. He prescribed drugs. He talked and listened.

Beecher and an assistant compiled nine treatment packages -- from attention-deficit disorder to postpartum depression.

"I don't know how it will shake out," Beecher said. "But I figured, what the heck, why not?"

Chen May Yee • 612-673-7434