Light in the Darkness: How Information Will Create Transparency in Healthcare
Presentation Transcript
Miriam Paramore
SVP Strategy and Government Affairs at Emdeon
August 26, 2010

Presented at “The Naked Hospital – A Provocative Look at Healthcare” a Nashville Technology Council super roundtable event., Miriam Paramore of Emdeon, mentions change:healthcare in reference to cost transparency in the healthcare industry.

http://www.slideshare.net/nashtechcouncil/light-in-the-darkness-how-information-will-create-transparency-in-healthcare

I always appreciate words of wisdom from someone who has “been there, done that” and Christopher Parks recent guest post on Catalyst Healthcare Research blog – For the Record exemplifies his experience with and passion for healthcare.

In Healthcare Costs, Transparency and Feeling Vindicated Parks says, “… the lessons we’ve learned about transparency and healthcare are really quite simple.  When you incentivize people to make value-driven healthcare choices and provide unfettered access to information about those choices, invariably consumers make far more insightful decisions about their care, its cost and its quality.  It’s simple common sense.  I have no doubt that with greater transparency placing more information and control into consumer hands, Americans could realize millions in healthcare cost savings.”

To learn more about change:healthcare, our cost transparency solution and the need to educat healthare consumers check out the Christopher’s entire post here and visit www.changehealthcare.com.

Christopher Parks was the guest blogger on “For the Record” by Dan Prince, President of Catalyst Healthcare Research. Read his entry “Healthcare Costs, Transparency and Feeling Vindicated.“

http://www.catalysthealthcareresearch.com/learning-center/for-the-record/2010/08/17/healthcare-costs-transparency-and-feeling-vindicated/

Great article from Jane Sorenson-Kahn pointing out that employers see “cost-sharing among employees as a top #1 cost-control strategy.” and that employers are “less satisfied [with] online comparison tools.” That’s a bad mix. No information on price AND you’re going to have to pay for it. Sounds like going to the auto-repair mechanic who just grins when he sees you walk in the door.

Let’s see if we can wipe that grin off of his face.

First, the Facts: Healthcare costs are out of control trending toward 16% of the GDP today and projected to be 20% by 2017 (that’s just around the corner, folks). So cost-shifting to the employee should come as no surprise. And with an economy like we’ve had and jobs as scarce as they are, employers have their choice of job candidates, so if you don’t like the health plan, there’s the door. So we are going to be paying the bills now. Time to put on the big boy pants and get serious. That damned mechanic’s grin just widened a bit.

Second, the Solutions: Most current online pricing solutions are relative scales where $ is inexpensive and $$$$ is expensive. When the treatment is $55-85 that MIGHT suffice, but when it’s $600-1,300 (like the MRI my daughter had on Friday), the difference between $ and $$$$ is significant. People WANT and NEED specific pricing information. Usually when you DO get pricing info, it’s an average negotiated rate, not the exact price (since doctors do NOT all get paid the same for the same service).  So even the “precise” number lack s precision. And I’m really getting sick of that mechanic’s smirk.

This is where change:healthcare steps in. We provide the tools that employers are telling us they have been looking for. We look at the services and prescription people receive, and then we proactively reach out to employees when they are paying too much for a service or a prescription and tell them exactly where they can go to get it for less. They don’t have to go where we tell them. It’s their money, and they can spend it how they want. But at least they know now. The mechanic has a bit of a surprised look on his face.

Oh, and then we monitor your employees’ spending for them. If prices change, we let them know that there are more cost effective options. Prices for doctors vary by 100% for many specialties. Prescriptions vary 40% between chains. We’ve seen diabetes maintenance medications that are $750/month at one pharmacy and $450/month across the street for the EXACT SAME THING.

We tell your employees.

We provide the online pricing tools employers have been looking for.

And we wipe that damn smile off of the mechanic’s face.

Employers, we hear you. We’re here to help.

Jane’s post is based on a PWC report that you can find here: “What employers want from health insurers in 2010.” Photo from user Neubie on Flickr.

Folks from coast-to-coast are talking about change:healthcare! The New York Daily News is talking about healthcare cost savings in the east, while the team was in California presenting as part of a panel at the Health 2.0 conference. And here at home in Nashville, the Venture Capitalist arena is buzzing about the company too. We are amazed by the number of people taking interest in saving money on their healthcare, and who trust us to help them out.

Below is a video from the Nashville NBC affiliate WSMV. The clip shows change:healthcare COO and co-founder Robert Hendrick working with the reporter to show people 4 ways to save on their medical costs.

All in all a very good week at change:healthcare! Thanks for all of the support, and for trusting us to teach you how to save money on your doctors visits and prescriptions, and to help you make smarter healthcare decisions.

Just got finished trying out the White House twitter site that allows tweeple to pop off a pre-formatted mantra in favor of healthcare reform. It’s a neat bit of technology – cool in many ways. But it’s an agenda pusher.

It’s all talk and NO action.

Now compare that with the recently-launched Twitter app from change:healthcare. It allows tweeple to receive information on health conditions and medication costs as well as prescription medication costs, generic alternatives and more using secure private messages via Twitter.

Government talks. Industry acts.

If you want to find the cost of prescription medication and medical term definitions via Twitter – Just Ask! Follow @askch on twitter and send a question in the proper format to see how you can change healthcare too.

Photo Courtesy of Bartificial on Flickr

Who knew prescription coupons could save me $75?!  I didnt…

I was speaking to my doctor this morning about a new prescription she suggested I try.  It sounded like a great option for me. As she proceeded to enter the information into their e-prescribing system, she told me that this drug could be expensive depending on my co-payment (what a novel concept – a doctor telling you cost information about the drug you are being prescribed).

I told her I was used to “sticker shock” being on a high deductible plan.  And thanked her for the heads up. We ended our call. About a minute later she called me back.  “I have a coupon here for $75 off your prescription and some samples. I can leave them at the front desk if you have time to come and grab them.”

“Yes, of course.  Thank you!” was my response.

Communication is key!  This morning I was inspired by her willingness to help me save money once she found out I would pay the whole cost for the prescription out of my pocket.  If you are willing to talk to your doctor about the weird stuff growing on your foot, or the pains in your back, why not talk to your doctor about the price of your prescriptions.  Now I know some people, possibly those still on standard co-payments for drugs, may not care (though you should). But those on percent co-insurance, high-deductible plans, and the uninsured certainly do.

Ask your doctor when being prescribed a new drug, especially if there is only a brand-name option available, if they have any samples or coupons!  If they don’t, search online. Often the drug’s website will include a coupon.  Here are just a few examples: Nexium,  Lipitor, Lunesta.

One final tip… check out the change:healthcare Field Guide on How to Save Money by Switching to Generics (pdf) for your prescriptions.

Image Courtesy of SqueakyMarmot on Flickr

“If you knew what the price of items were at Wal-Mart before you went into the store to buy them, it would put Wal-Mart out of business.”

That has to be one of the single most insane statements ever written.Yet that’s exactly what many doctors and hospitals would have you believe about healthcare. If you knew the price before you went into the doctors office or hospital, it would put the healthcare provider out of business.

Excuse me?

No. It would not. In fact, it might make the patient consider whether they needed that service or not. It might make them question if they really need all 8 prescriptions.It might make the provider find ways to offer the procedure more cost effectively as John Stossel so elegantly pointed out about Lasik eye surgery.

When someone hesitates to tell you the price of an item, why do they do it?

4 Reasons Why People Hesitate to Tell you the Price:

• They are ashamed at having to charge that much
• They do not believe the product is worth the cost
• They prefer you make an emotional commitment to purchase before knowing the price
• They simply do not know the price (the fallback reason in healthcare)

Fortunately, rational thought does occasionally prevail. The recent post from KevinMD.com points out (from the physician’s perspective – no less) that price transparency won’t effect health care costs.

It won’t adversely impact the cost of healthcare. It will force providers to be more cost effective and up front about their costs. It will force consumers to be more selective and engaged in the purchasing decision.

But will knowing the price put healthcare providers out of business? Not likely. In fact, knowing the price seems to be working wonders for Wal-Mart and…oh…just about every other business model in the U.S.

Shannon Buggs at the Houston Chronicle has written a great piece “Close Look at Hospital Bills Saves Money” on taking a closer look at your hospital bills for errors.  Though there have been numerous pieces on this topic, this one in particular (find it here) has  some great tips included at the end. I have her “common errors to look for on your bills” below:

Wrong names: If you or your insurance company’s name is misspelled, there is a chance the hospital did not correctly calculate the charges based on your actual coverage plan.

Clerical errors: The two pills you took while in the hospital are input accidentally as 222 pills. Those typing mistakes are simple to correct and costly to let stand.

Extra dates: Your insurance company may not pay room-and-board fees for discharge days, but your bill may include a charge for that date. Also make sure you are not charged for a hospital stay for the same day you visited the emergency room if your treatment resulted in a post-midnight hospital admittance.

Out-of-network charges: Follow up with your insurance company to make sure the hospital contacted your insurer to get all necessary approvals before doing procedures.

Brand-name substitutes: Compare the doctor’s orders to the hospital bill. If the physician ordered a generic medicine commonly stocked in hospital pharmacies, but the hospital substituted a more expensive brand-name drug, you should not have to pay the higher cost.

When you log into your free change:healthcare account, its simply not the same as logging into an account sponsored by your TPA (third party administrator) or employer.  But why? The simple answer is “data”.

In recent weeks we have done a lot of work on the site, considering ways we can improve the experience for our consumer users.  Hopefully, you have noticed our efforts. We plan to continue to work identifying ways to help you save on your healthcare without having your data.

However, when we are working with your TPA or employer we are able to pull in your specific healthcare claims data.  What does this do?  Well for starters it allows change:healthcare to perform a review of your spending and present you with opportunities/ways to save on your healthcare.  Most importantly, these ways to save are specific to your healthcare spending, the prescriptions you take, and the providers you saw. The red circle in the image below identifies our cost savings alerts.

Additionally, we are able to  provide you with detailed reporting on your healthcare spending, as well as alternative providers seen by your peers for the same services.  You can research these specific providers though change:healthcare’s easy to understand profiles, which contain information on cost and quality. Our detailed reporting can be accessed through one of these two icons on the dashboard.  One provides extended information on ways you can save money, the other provides detailed reports on where you went and what you spent, alongside where your peers went and what they paid for the same services. An overview of your detailed reporting is present in the left hand column.

Please let us know if you have any questions or are interested in learning more about our employer and TPA products!