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

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/

Bringing Comparison Shopping to the Doctor’s Office
New York Times: Claire Cain Miller
Published: June 10, 2010

Even if a patient does want to comparison-shop, there is no easy way to obtain complete and useful information. It is a hole in the market that some companies see as an opportunity, especially because many Americans will soon have to pay more attention to what they are paying for, rather than count on insurance to cover everything.

But there has been no easy way for consumers to shop for the best deal on a colonoscopy or blood test. A start-up financed by prominent venture capitalists and theCleveland Clinic, Castlight Health, aims to change that by building a search engine for health care prices. Patients using Castlight could search for doctors that offer a service nearby and find out how much they will charge, depending on their insurance coverage.

A few others are starting to publish health care prices, including Thomson Reuters, a Tennessee start-up calledChange:healthcare, the New Hampshire government, which created a comparison shopping tool for residents, and health insurers. Aetna, for instance, has built tools to help patients estimate prices and may build more advanced tools, said Lonny Reisman, Aetna’s chief medical officer.

Price transparency could significantly change the way health care is bought in the United States. The notion “seems ridiculously simple and obvious, and in any other industry, you would say, ‘Duh, we already have that.’ But in health care, it’s revolutionary,” said Alan M. Garber, a professor of medicine and the director of the center for health policy at Stanford, as well as an investor in Castlight.

The lack of price information in health care has been a big driver of ballooning health care costs, analysts say, because costs are opaque to patients and heavily subsidized by employers. The patient has no incentive or responsibility to keep costs down. But many employers are switching to health plans that require patients to pay more out of their own pockets.

“Since Americans started having employer-sponsored health care, people are paying with someone else’s credit card, so we created a very inefficient market,” said Giovanni Colella, chief executive and a founder of Castlight. “Creating the right incentives changes the way people behave, and that’s where our company comes in.”

Dr. Colella started RelayHealth, which connects patients and doctors over the Web and was bought by McKesson in 2006. He founded Castlight with Todd Park, a founder of Athenahealth and chief technology officer of the federal Department of Health and Human Services.

On Thursday, Castlight announced that it raised $60 million from investors, in addition to the $21 million it previously raised. Safeway, the grocery chain, with 200,000 employees, has signed on as its first customer.

Castlight has received money from investment firms including Venrock, Maverick Capital, Oak Investment Partners and from an unlikely source, the Cleveland Clinic. Hospitals’ business models could be turned upside-down by price transparency.

Several studies and pilot projects suggest that the more patients know about prices, the more money they save. A study published last month by Mercer, a human resources consulting firm, found that people on high-deductible health plans, with more exposure to the prices of doctor visits, spent less. Indiana adopted high-deductible health plans, and the average expense in 2009 for patients on one of these plans was $6,393, compared with $8,570 for patients on a more traditional health maintenance organization plan.

“A lot of it is to understand the driver of costs and how they can start to control that, and encouraging that debate to happen while in the physician’s office,” Dr. Colella said. Castlight is working on a mobile version of the service to introduce next year so people can access the information from the exam table.

Health care pricing became part of the national conversation during the debate overhealth care reform. Prices will be important for the 30 million to 40 million people expected to join exchanges, which will encourage comparison shopping.

But so far, prices have been very difficult to find because health insurance providers and doctors negotiate rates and often agree not to reveal those numbers for competitive reasons. The Cleveland Clinic, for example, has about a hundred different contracts with insurance carriers, each with a different rate for a given procedure.

Ideally, transparency in health care pricing could lead to higher-quality, lower-cost health care, and more patient involvement in buying health care, said Delos Cosgrove, chief executive of the Cleveland Clinic. “Because they begin to realize that a trip to the doctor is not free, they might stay home and take the aspirin instead of getting the neurologic work-up.”

Castlight sells its service to employers and charges by employee per month. (It plans to eventually introduce a Web site for anyone to use.) Employees log on to a search portal, where they enter something like “colonoscopy” to find a list of doctors nearby and how much they charge.

Some insurers have shared pricing with Castlight, but the company gleans most of the information from the explanation-of-benefits forms that patients receive after a doctor visit. Castlight developed a way to pull the information from the millions of forms provided to it by employers.

Anyone who has read an explanation of benefits knows that it often raises more questions than answers, and Castlight says it wants to provide health education in addition to price information. The site explains why a patient has to pay a certain amount and the standard number of tests that a doctor would order for a particular problem.

Safeway has been experimenting with ways to cut health costs, including by using Castlight. “I’m a big believer in trying to create market forces wherever you can and then let personal accountability really drive the result,” said Steven A. Burd, the chief executive of Safeway.

For instance, Safeway pays up to $1,200 for its employees’ colonoscopies, a preventative procedure to detect cancer. If employees wish to go to a doctor who charges more, they must pay the difference. According to Castlight, colonoscopies in the Bay Area, where Safeway is based, range from $500 to $3,000, and sometimes a doctor charges different rates at different hospitals.

Castlight plans to add quality measurements to its price information. There are already several providers of that information, though there is no standard set of quality measurements in medicine. But even with quality ratings, there are many procedures for which Castlight’s service is not applicable. Someone suffering a heart attack is not going to check the Web before calling the ambulance, and a patient who discovers he needs emergency brain surgery is likely to prioritize quality above all else.

Even for more basic services, pricing is not always cut-and-dried. The delivery of a baby, for example, includes the hospital stay and the obstetrician’s fees, but could also include fees for a pediatrician, an anesthesiologist and specialists if there are complications.

At this stage, Castlight works best for big companies that are self-insured and for outpatient doctor visits for which quality does not vary greatly.

http://www.nytimes.com/2010/06/11/technology/11cost.html?emc=eta1

In less than a week, a few of us will be in San Francisco for the Health 2.0 conference as well as attending the HealthCamp SF Bay. We are excited to be part of such an innovative group of folks trying to make changes in the healthcare world. You may be asking… what is this HealthCamp thing?

What is HealthCamp

HealthCamp is about putting social media, open source and the best of the Internet, Mobile Web and process innovation to work for better health care and health technology. HealthCamp is a user-organized “un–conference” movement that brings consumers, health providers, health industry experts and technology professionals together for a one day event to exchange ideas informally, locally, openly. Participants themselves provide the content, with break-out sessions they develop themselves and plug into a schedule grid on the day of the event. Anyone can present and host a session in nearly any format.

#HCSFBay is our hashtag on Twitter, please use it and spread the word!

How to Find Us

Well, if you don’t know who we are or what we do, you can take a peek at our sexy personal detiails to see pictures and bios for us (Christopher Parks, Robert Hendrick and Chris McIntyre). If you are wondering what we do, head on over to http://www.changehealthcare.com and see how we can help you save money on your health related expenses.

Make sure you follow us on Twitter, that is the best way to keep up with us when we are on the road!

• Christopher Parks – @caparks
• Robert Hendrick – @jrh3
• Chris McIntyre – @theferf
• change:healthcare – @askch

See you there!

HMS (Healthcare Managements Systems Inc.) announced August 7th (I know, I am a little behind) that they have an online bill payment tool available for hospitals.  This would allow them to send bills and statements electronically, as well as recieve online payments from patients.

Excepts from their announcement: “Our online bill pay product creates a particular advantage for the facility by allowing patient payments entered through a hospital’s web portal to be automatically updated in their HMS Patient Accounting solution.”

“The new HMS online offerings are a vast improvement over our previous solution,” said Michael Pracheil, Thayer’s chief financial officer. “Now our patients can click a link on our hospital website and see past bills, set up recurring payments or make a one-time ACH transfer or credit card payment. Our hospital staff has access to the same information so they can work with patients to set up electronic payments over the phone.”

Though there will be slow uptake and some patient resistance to use new online technologies relating to their medical care…  This a step in the right direction!  Reducing paper flow and processing will save the system both time and money, hopefully cutting some administrative overhead. If given the option to participate in electronic billing with your medical provider… at least take a moment to ask questions and consider the option!

By: Kat Sanders (more info on the author below)

There was a time when you had to choose between engineering and medicine even though you were equally inclined to both. The situation has undergone a vast change today, and you have common ground between technology and medicine in the form of healthcare IT. Although it is a relatively fledgling field, it is beginning to become popular by the day even though there are still various hurdles that need to be crossed. If we’re gunning for the success of healthcare IT and EMR systems across the entire healthcare spectrum, we need to ensure that:

• The doctors are as much a part of it as the tech guys: When a system is designed, it goes without saying that the end user must be the most important person to be considered. It is their use and comfort that must be put above everything else. So a system must be designed to suit doctors’ needs rather than be the most sophisticated of its kind.

• The system is easy enough for even the older doctors to understand: The younger crowd of medicos is more tech-savvy and able to relate to the meeting point between technology and medicine and harness their iPods and iPhones to provide them with the information they need to treat their patients much more efficiently. It’s the older ones who are skeptical about the new-fangled technology and reluctant to use it. They must be targeted, trained and convinced if EMR systems and other IT innovations related to healthcare are to be a universal success.

• The doctors with more experience are roped in for their expertise: One way to involve the older doctors and specialists is to enlist their help in preparing knowledge bases that are then interpreted and translated into IT systems using the correct logic. They are there to give the tech personnel their expertise so that it can be used to provide accurate information when treating patients.

• The medical personnel are given enough training: A system is only as good as the person using it, so unless a doctor is given training in using the system, it could turn out to be a damp squib. There will be an initial resistance period, but with persistence, doctors who welcome positive changes are able to understand that this is the future of medicine and patient care.

• Any change is consensual and cooperative: And finally, any new changes or additions to the system must be made only with the consent and cooperation of the people who are using them. Only when there is a mutual understanding between the people who write the systems and those who use it will be possible for these healthcare IT systems to become a routine entity in every hospital and healthcare facility across the world.

This article is written by Kat Sanders, who regularly blogs on the topic of surgical tech schools at her blog iScrub. She welcomes your comments and questions at her email address: katsanders25@gmail.com