The city of Manchester, N.H., has saved more than $250,000 in health care costs in two years by participating in Anthem Blue Cross and Blue Shield's Compass SmartShopper program, which pays employees cash rewards if they get a test or procedure at a facility that is less expensive than the one recommended by their physician. Harvard Pilgrim Health Care has a similar plan called SaveOn, but physician groups say these programs do not consider quality, only cost.

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