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- Non-hospital options like virtual care, urgent care, and retail clinics often provide same-quality care with lower costs and shorter wait times.
- Hospital outpatient departments add facility fees; consider ambulatory surgery centers for many routine procedures to reduce expenses and simplify care.
- Use Anthem tools such as Sydney® Health to compare in-network locations, estimate costs, and get navigation support for informed choices.
The Rising Importance of Choice
Many people have experienced it: an unexpected illness or injury disrupts the day, or routine bloodwork gets pushed further down the to-do list.
Today, people have more choices than ever for receiving routine care, from virtual care and urgent care to retail clinics and ambulatory surgery centers. But where people receive care can significantly affect both costs and the overall experience.
For routine or non-emergency care – such as diagnostic imaging, lab work, infusions, and procedures that don’t require an overnight hospital stay – people typically have two categories of choice:
- Hospital-based outpatient settings, where people receive care without being admitted overnight; and
- Non-hospital settings such as your primary care doctor, urgent care clinic, or virtual care.
For example, virtual care may be a convenient option for flu-like symptoms, allergies, rashes, or sinus infections, while urgent care may be more appropriate for sprains, ear pain, or minor injuries.
But different care settings come with different price tags. For example, research consistently shows that hospital outpatient departments charge more due to facility fees, even when the quality of care is the same. A recent study found that infusion care received in hospital outpatient departments resulted in 42% higher costs than care provided in non-hospital settings, despite similar outcomes and patient experience. In many cases, people can receive the same high-quality care in lower-cost settings, without sacrificing outcomes or convenience.
The challenge is that these cost differences can be hard to anticipate. While the emergency room (ER) may seem like a good choice for last-minute care needs, it typically costs more and takes longer than other non-emergency care options.
That’s why helping people understand their options and identify high-quality, lower-cost alternatives is a core focus for Anthem. Through care navigation tools and support, members in Georgia can compare care locations, understand potential cost differences, and explore lower-cost, high-quality alternatives when clinically appropriate.
Why It Matters: Cost and Care Experience
When people default to higher-cost settings without understanding their options, the impact goes beyond cost alone. They may also encounter more complex, fragmented care experiences that feel harder to navigate, particularly for services that are non-urgent. Care settings outside the hospital may offer more convenient experiences, including shorter wait times, easier scheduling, and care closer to home. Plus, there are no hidden facility fees.
One non-hospital option that may be lesser known to people is ambulatory surgery centers. These centers can perform many of the same routine outpatient procedures as hospitals, such as colonoscopies or upper gastrointestinal (GI) procedures, but at a lower cost. In fact, people can save roughly $1,000 per surgery when procedures are performed at an ambulatory surgery center.
When people have access to this information earlier, they can make decisions that best serve their health needs and budget.
How Anthem Can Help
For Anthem members in Georgia, these tools and resources can help people find the right care, in the right place, at the right time, resulting in lower costs, fewer surprises, and care that feels easier to navigate.
Through the Sydney® Health app, members can search for in-network providers, compare care options and costs, access their digital ID card, review benefits, and check claims—all in one place.
Members can connect to care conveniently through virtual care visits and receive support navigating their benefits and provider options through live chat or by calling Member Services. Personalized recommendations and secure access to health records help members make informed healthcare decisions.
For behavioral health needs, members can use Anthem’s Virtual Care Hub in Sydney® Health, which includes quick access to providers such as LiveHealth Online and Headway, or they can visit our online provider-matching tool to connect with behavioral health professionals based on their specific needs and preferences.
Beyond healthcare access, Sydney® Health supports members’ overall well-being with personalized wellness resources, secure access to health records, and connections to community services such as food, transportation, and childcare assistance. These tools help connect members with resources and support to manage their overall health, which leads to better health outcomes.
Knowing where to go for care is not always easy, but Anthem can help simplify the decision-making process. For many common health concerns, people may have options such as virtual care, urgent care, retail clinics, or a doctor’s office that can save time, lower costs, and reduce the stress of unexpected medical bills.
Learn more at anthem.com/healthcareingeorgia.
Amanda Free, President, Anthem Blue Cross and Blue Shield in Georgia
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