Text Size: More information: PHP Cost of Care
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How does it work?
Providence Health Plan’s Cost of Care tool uses a data gathering method known as Episodes of Treatment Groups (ETGs) for gathering health care costs. ETGs are created by collecting specific records that are submitted to the health plan for payment. The records include diagnosis codes, procedure codes for hospital and lab services, and pharmacy information. Using the ETG system, types of care, services and medications for a similar diagnosis over a period of time is considered an “episode” of treatment.
This method allows us to consider how much care will cost for a diagnosis like “sinus infection,” which will include medical costs, pharmacy, etc. We gather cost information from PHP member claims data for three geographic areas because costs can vary between urban and rural areas for many reasons.
There must be at least 50 sets of ETG information for any condition in a geographic area for the costs to display. Costs are displayed as minimum (lowest in the range), median (the middle of the range) and maximum (the highest cost in the range). By sharing the range and variation in costs that can occur, PHP members can understand and learn about the costs of care, and what their own costs may be.
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Browse within these 13 main categories for conditions and care costs.
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Costs for the most frequent reasons Providence Health Plan members go to the doctor.
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Doctor/Other
Physician office visits and medical expert care costs.
Facility
Costs for using hospital rooms, skilled nursing facilities or other medical locations; primarily, the patient’s costs for the stay (room, food and miscellaneous items).
Surgery
Costs for a surgeon, surgical staff and surgical suite for a procedure.
Inpatient
Care and tests provided to a patient staying in hospitals, skilled nursing facilities or other medical locations.
Outpatient
Care and tests provided to a patient in a freestanding clinic, lab, hospital or other facility where the patient does not stay overnight.
Rx
Costs for medications used to treat a condition over the course of the episode of treatment. Costs may include both prescription and non-prescription medications, if covered by health plan benefits for that condition.
Geographies
Portland
Includes most of the ZIP codes in Multnomah, Washington, Clackamas and Yamhill counties.
Eugene
Includes most of the ZIP codes in Lane county that are included in the PHP service area.
Non-Metropolitan
All other ZIP codes in Oregon and Washington counties included in the PHP service area.
Health Information Library
Learn more about each health condition.
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