How HCF is making out-of-pocket costs more transparent

HCF’s Chief Medical Officer Dr Andrew Cottrill explains how HCF was one of the first healthcare funds to make out-of-pocket costs more transparent for our members. 

For 90 years, Australians have been trusting HCF with their health and wellbeing, and in return we’ve invested in their lives, providing quality cover and healthcare that’s right for them. We’ve invested through establishing a network of high-quality dental and eyecare centres. We’ve invested through our Research Foundation, a charitable trust which was set up to drive improvements in health services delivery for all Australians, as well as launched Australia’s first corporate-backed health-tech accelerator, HCF Catalyst.

We’ve pioneered the prioritisation of members’ overall health and wellbeing with chronic condition programs like My Health Guardian. And we’ve also challenged ourselves to help members in practical ways to access healthcare with affordability and quality in mind.

Chief Medical Officer, Dr Andrew Cottrill, says, “One area where we bring our experience and assets to bear for our members is transparency in healthcare. So often people don’t understand what lies ahead when they’re going into a healthcare journey – what to expect clinically and what sort of cost to expect. We know that winding your way through the labyrinth of our healthcare system can be daunting.”

First health fund to make out-of-pocket costs available to members

Dr Cottrill spearheaded the launch of our Dr Gap tool in 2019, which is an online platform that makes the cost of procedures more transparent. He explains: “First we launched the cost indicator in 2016, which shows the average total costs and out-of-pocket costs incurred by HCF members. Then in 2019, we launched our Dr Gap tool, also called the Find a Provider tool, which saw HCF unlock our data for the value of our members. For all of the major procedures they could see what the total cost was, how much Medicare pays, how much HCF pays and how much is out of pocket. We were the first fund to get that off the ground and very quickly our competitors jumped on the bandwagon and copied.”

Soon after launching the first iteration of the tool, we were the first fund to share specialist-level information on out-of-pocket expenses for a particular procedure. With the Dr Gap tool, you could search for a provider and see what sort of out-of-pocket costs they would be charging for procedures they perform – it doesn’t necessarily guarantee those costs will be the member’s experience but it gives them an idea. We were the very first fund to do that.”

The Dr Gap tool is based on the digital platform, developed in partnership with HealthShare, and was the first of its kind in Australia, designed to ensure members have the tools they need to avoid or minimise gap payments and understand the costs.

“Fees can vary widely between medical specialists and it’s difficult for consumers to make informed decisions when selecting healthcare providers. We’ve always advocated for increased transparency around costs for our members. By developing this platform, we empowered our members to make decisions with a greater awareness of the potential out-of-pocket costs they may face,” says Dr Cottrill.

What was the driver to launch this out-of-pocket tool?

“We see and we listen to members’ feedback and complaints. In all our surveys, when we ask what’s the biggest issue, it’s always the gap. We see the egregious charging of some specialists and it’s not simply that your health insurance isn’t paying enough, it’s got to be a balance – if we pay more it creates more opportunity for prices to shift up.

“So to some extent, one of the answers to keep costs down is to share information – transparency helps people make better choices and helps iron out the market inefficiencies,” explains Dr Cottrill.

What else is HCF doing to demystify healthcare?

Dr Cottrill says, “Another first for us is our preparing for hospital material. When members go for a procedure, they want to know what to expect, so we curated this material with input from specialists both globally and within Australia. It’s a multimedia resource that provides content like three-dimensional video animations and written guides with helpful information curated from Australian and international specialists,” Dr Cottrill explains.

“We also interviewed members who’ve already had these procedures, so we have these videos of people sharing their personal health journeys to try and help our other members.

“As we add more and more resources to that library, we’re building on our Uncommon Care philosophy. Ultimately we see ourselves not just paying the bills, not just at the end of a whole chain of events that have occurred – we want to be a health partner for our members, so we have some input earlier on in their health journeys, breaking down the barriers, making sure they get an as efficient health outcome as possible.”

Ninety years on, we remain constant to our not-for-profit ethos, continuing to provide the highest standard of healthcare while returning more benefits to our members, not just in claims but in Uncommon Care, creating a health partnership. As Dr Cottrill explains: “People feel vulnerable during this time, so if we can make that any simpler, that’s a good thing. And we do it with credibility, genuine empathy and compassion.”

Published September 2022