What measurement means for the total cost of care

The total cost of care is the full cost of health care that is paid by both patients and health insurance companies. Using measurement methods endorsed by the National Quality Forum, the total cost of care reports on MNHealthScores.org allow you to compare all participating medical groups and see differences in cost.

Measuring total cost of care in three areas
  • Overall total cost of care for all patients
  • Total cost of care for adult patients
  • Total cost of care for child (pediatric) patients

The 2016 results include 120 medical groups that represent 1,030 clinics in Minnesota as well as neighboring communities in Wisconsin, Iowa, North Dakota and South Dakota. Groups needed at least 600 patients with claims across at least three health plans to be included in the results, to ensure accuracy. All patients are included in the statewide averages, including those who were seen at groups that were not reported by medical group due to having less than 600 patients.

The statewide averages show the average monthly health care cost for three different populations:

  • $474 average monthly cost overall for a patient (all patients)
  • $558 average monthly cost for an adult patient (adults ages 18 to 64)
  • $238 average montly cost for a pediatric patient (children ages 1 to 17)

For overall cost, individual medical group results ranged from $365 to $914 per patient per month.

Higher cost doesn’t always mean higher quality

Comparing information about care quality and patient satisfaction along with cost will help you focus on options that offer you the highest value.

Use the reports on MNHealthScores to compare clinics, medical groups and hospitals on their performance, see how patients rated their care experience, and look up the costs of specific procedures and services, based on what’s most important to you and your family.

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Want more information about how to get the most value for your health care dollars? Visit Managing Costs for links to recommended resources and websites.

Looking for information about the cost of procedures, tests or services? Learn more about the average cost of procedures.

How we calculate the measure

We measure the total costs associated with treating commercially-insured patients. The information is based on 2015 claims data from the four health plans in Minnesota with the largest commercially insured populations: Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica and PreferredOne.

It includes the actual costs of more than 1.5 million patients insured by the four Minnesota-based health plans. The costs accounted for in the claims evaluated for this report totaled $8.9 billion. The data is analyzed to create the medical group-level measures. The technical measure name is Total Cost of Care.