A system for obtaining information for a health care service prospectively to be rendered by a health care provider for treatment of at least one health condition, the system comprising:
- a computer database system for a health plan organization including cost information for health services provided by one or more health care providers in a collection of providers, the cost information comprising a first monetary amount that the one or more providers would charge for rendering health services and/or a second monetary amount that the one or more providers would be compensated by the health plan organization for rendering the health services;
- a computer processor;
- and
- a computer readable medium having stored thereon computer executable instructions that, when executed by the computer processer, cause for:
- transmitting, via a network, consumer identity information, the identity information corresponding to a health care insurance plan offered by the health plan organization;
- specifying, via an electronic user interface, query criteria for provider-related information including a selection of the health care provider;
- transmitting a query comprising the specified criteria to the computer database system for the health plan organization;
- determining a treatment cost efficiency metric for the health care provider corresponding to the selection based on a total cost of treatment of the at least one health condition by the health care provider rendering a health care service, including:
- grouping health care insurance plan claim data for the health care provider into an episode treatment group based on at least one of procedure codes and diagnosis codes associated with the claim data for the health care provider;
- associating the claim data in the episode treatment group with the at least one health condition;
- aggregating costs for the claim data within the episode treatment group for measuring the total cost of treatment from the health care provider of the at least one health condition;
- and
- calculating the treatment cost efficiency metric for the health care provider corresponding to the selection as a percentile ranking among a plurality of health care providers of the total cost of treatment of the at least one health condition;
- receiving, from the computer database system and in response to the query, information relating to the health care provider, the information comprising the treatment cost efficiency metric for the health care provider, cost information, and quality information, wherein the cost information is based on the first monetary amount and/or the second monetary amount under the contractual relationship and in accordance with the health insurance plan, and wherein the cost information and the treatment cost efficiency metric are received from the computer database system prior to the first health care provider performing the health service;
- presenting the cost information and the quality information for the health care provider, wherein the quality information includes indicia for each of:
- compliance of the health care provider with predetermined quality criteria, a frequency of adverse reactions in past patients of the health care provider, rates that past patients of the health care provider subsequently have sought similar health care services, an indication of whether the first health care provider uses latest procedure, and comparison of the indicia to industry standards;
- and
- receiving, from the computer database system, cost information and quality information relating to a second health care provider, the second health care provider also under a contractual relationship with the health plan organization, wherein the received cost information and quality information for the health care provider and the second health care provider are presented in a comparative arrangement.