#CareTalk Shorts – The Healthcare Transparency Trope

#CareTalk Shorts – The Healthcare Transparency Trope


– Welcome to CareTalk Shorts, where we take one
important healthcare idea and cover it in depth. I’m David Williams, President
of Health Business Group. – And I’m John Driscoll,
the CEO of CareCentrix. – John, let’s talk about
transparency today. – One of my favorite topics. – What does transparency
mean in healthcare? – Well, I think what
you’re really getting at is the move from the White
House and the administration to push for more transparency, but transparency in healthcare would be, from a patient perspective, you’d like to know what you’re gonna pay, what services you’re gonna get and how you’re gonna get taken care of. It’s really soup to nuts, what you’re paying and how
you’re being cared for. – John, and I’ve never really
liked this term transparency. Now if I think about transparency, I think about, like, a plate glass window and a bird flying smack into it, okay? They didn’t see it, there was something on the other side they wanted,
it just doesn’t really– – Very isosteric. How does that–
– Yeah because– – How do you tie that to healthcare? – Yeah because, okay, so, I’m gonna go to the emergency room, okay? Now, I really care. Oh, look there’s a list
of all the 35,000 things they could do to me. What is that gonna help me with? – Oh, come on. Don’t you wanna know,
when you go to the ER, what it’s gonna cost? I mean–
– No! – You should at least be,
I think that healthcare should have an obligation, where possible, to share what the cash
price is and if possible, exactly what you’re gonna owe. Look, 1/3 of all Americans
who have prescription drugs can’t afford them. I think there’s probably a lot
of other areas in healthcare where people are getting
bills they don’t understand or would like to know what
the difference in cost is. I mean, honestly, the
difference in MRIs, for example, which you can shop for, can
be as much as five or 10 times in terms of cost.
– You know– – Whether you get your
labs done at a hospital versus outside of a hospital,
just across the street, in many cases, can be the difference between two to three times
and those are dollars out of hardworking American’s pockets. – Hardworking American. Now, my kind of people, John. – Yeah, but don’t you think transparency– – I respect them. – Don’t you think, as a consumer, you should know something? – Yeah, probably, but
I think when I’m going to the emergency room,
I don’t care about that. John, here’s what happens when you make emergency
room prices transparent. Who looks at those? The people that negotiate
prices for emergency rooms, not the patient. – Well– – Somebody says, oh,
that hospital across town is getting twice what I’m getting. I’m gonna jack my price up. – Not surprisingly,
you’re missing, kind of, a subtle point that’s super important. – Yeah. – I think a lot of
Washington is obsessed with the prices in the marketplace
and the evidence would show, economic research would show
exactly what you’re saying, that when you provide more information about what the big boys,
hospitals and doctors, are getting reimbursed at,
provide that information in the marketplace, prices tend to go up and that would not be
helpful, or nothing happens. In New Hampshire, they’ve
had, the last few years, a law that requires healthcare
pricing transparency and it really hasn’t affected cost trend. It’s sort of a myth that providing more
total price transparency is gonna lead to lower costs. It actually hasn’t affected costs at all, but I do think that the average
patient really wants to know to the extent, from their
insurer, from their doctor, from their hospital, what
they’re likely to be at risk for because people are still
going into bankruptcy who can’t pay their bills. So some element of transparency. You’ve gotta be for some
element of transparency. – Okay, John. So this is a real example of a dysfunction of the US healthcare system. I would wager–
– You and me, or? – The screen, no, John, here’s the thing. I bet price transparency in healthcare is something of interest
only in this country and it’s only a result of having this wacky third party payment system. I’ll tell you what transparency
I care about, John. I care about the transparency
related to quality. I might–
– Great point. – Okay, that’s what I care about. – But prices still, I mean, the cost to me still matters, dude. – Well, I think that’s already figured out with what kind of health
plan that you have. So all right, so now the
president has this thing, they’re gonna have transparency. I think it’s just basically an excuse for doing really nothing. You’re just gonna make it transparent, you’re gonna see it,
and then Trump thinks, well, all of the sudden you won’t imagine, you can’t believe how much
price is gonna go down. – Well, there is a market myth that providing more total cost information is gonna affect cost trend. It hasn’t happened, it won’t happen, prices are actually likely to go up and pricing and total cost
is the biggest problem. And I agree with you in terms
of transparency on quality, but what does that meant to you? – So–
– How would you measure it? – Well, so John, well it
depends on what it is. Like, if I’m gonna go in– – Well you brought it up. – If I’m gonna have, yeah,
so if I’m gonna have surgery, I wanna know, am I gonna
survive more likely with this doctor or with somebody else? That’s what I would like to know. And I’d like to know where do you care about
price transparency? Where would that have made
any difference to you? – Well, I have the good fortune of having a great health plan that pays for most expensive things,
but not everybody does. There’s a lot of folks
in high deductible plans. I think that there’s a small
important idea embedded in what the transparency
conversation’s about, which is we’ve gotta
get better information to patients and family members about what healthcare’s gonna cost ’cause it still costs too much. But there’s also, to your
point, and a surely myth, that providing more market information is gonna bring costs down. We’ve got market evidence from states like New Hampshire and others that it doesn’t actually
pierce that high cost level that’s continuing to go up. I love your idea on quality. Why hasn’t that happened, David? – Well, I think where it has happened is in places like primary care, but then they’re just
talking about measures like what percentage of people got vaccinated and it’s hard to really
make good comparisons to have a high enough end, and again, it actually partly goes back
to the fragmented payer system ’cause a lot of the information
comes from the claim system and things are reported differently from one payer to the next. – I thought, honestly,
that was an easy question ’cause I thought you
really made a good point and you’re missing the fact that we actually have more
information, now to your point, than we’ve ever had on
mortality and morbidity. I think it’s important to
publish that information and to also publish just
how many times doctors have done certain procedures. You know, it’s pretty clear that after a couple hundred cancer surgeries, you’re a much better
surgeon than your first few. Patients and consumers should know that. We should know whether
certain places are good at cardiac care and
cardiac surgery or not, based on mortality and
morbidity statistics. Historically, that data wasn’t available. Now there’s a lot more data
available in a wired system. So I love your idea of quality around, of more transparency around quality, but I wouldn’t diss
transparency in general. – So John, here’s how
I would reconfigure it. – Okay. – So instead of expecting the
patient to be the consumer, I would configure it so we
have a value based system where we’re putting the responsibility on the primary care physician to help manage quality and cost and I would like the
primary care physician to be able to evaluate
the different surgeons, and have the data to do that, and their business manager,
or even the physician, to be able to understand the
different cost sides of it and have them help to manage it and don’t put the onus on the patient. That’s where I’d like to see it go. – I think you got too
much trust in the system. Once you shift to value based care, you’ve run the risk of
actually being locked into a closed system of referrals where you actually may
not get the opportunity to shop for quality. People are talking
about shopping for cost, I agree with you, that’s unlikely, but I would like to know
what things are gonna, what I’m gonna have to
pay when my kids get sick. But I actually think that
what would be more powerful is more transparency
around quality statistics and performance statistics
and just frequency statistics available to consumers. I will bet on an informed consumer because I think if consumers
have better information about what works and what doesn’t, they’ll more likely go to
the hospital and doctors that are driving better outcomes. – So John, last question
to wrap things up here. How important is transparency
in the whole, kind of, panoply of different solutions
that we have out there? Is that an important thing in healthcare? – You know, I think
transparency is important, but a little bit like
Medicaid work requirements, there’s this market myth that healthcare is like every other market. It’s not. When you’re sick, you
don’t wanna shop for– – Shop ’til you drop.
– Shop around price, you wanna shop around
quality, to your point. You’re completely vulnerable and at an informational disadvantage. This is a market myth, but I do think there’s
an element of value here that you shouldn’t completely diss, which is that more information is available now than ever before. We can actually stack and
rack performance statistics so that consumers can get information that previously has been hidden and I think we can, with the tools that are starting to become
from health insurers and others, figure out how much things cost. So it’s a problem that we
can solve and we should around quality and what
patient’s obligation to pay are and we shouldn’t subscribe
to this market myth. That’s my view. – All right John, we’re
gonna leave it at that. So, that’s it for this
edition of CareTalk Shorts. I’m David Williams, President
of Health Business Group. – And I’m John Driscoll,
the CEO of CareCentrix. Thanks for watching. Hey there listeners. Want more CareTalk? There’s more to be had
in our other episodes, so be sure to look for those
and subscribe to CareTalk on your favorite service. (slow music)

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