Jim’s Take

Transparency in Healthcare As A Corporate Cost Control Strategy

Recently, an article appeared in Revcycle Intelligence, a medical industry website (https://revcycleintelligence.com/news/patients-want-healthcare-price-transparency-but-few-seek-it-out).  I was drawn to the headline because it seems to suggest a conflict your employees are dealing with — and it’s costing you money.

It also underscores a never-ending conflict between the desire for something and the willingness to do the work needed to acquire that something.  Most of us stop short of actually going after the things we “want”.

The article was angled to medical practitioners, not employers, but in my opinion it has more value for an employer.  The title was “Patients Want Healthcare Transparency, but Few Seek It Out.”

It referred to a recent Massachusetts survey stating

  • 7 of 10 consumers said they wanted to know provider prices, but
  • fewer than half ever thought about seeking it out.
  • 70% were unaware that their carrier offered a cost estimator tool.
  • And only 20% had ever tried to find pricing info before getting the procedure or service.
  • 15% actually believed the cost would be the same irrespective of where they got it!!
  • Only 10% knew how to get it

This, even though 69% of American have less than $1,000 in savings.  Even though 45% have NOTHING in savings.  Even though 69% of your employees are one medical emergency away from bankruptcy.

This despite transparency regulations that require the information be available.  By law Mass providers must give consumers, if asked, within two days, the price of any procedure.

Further, the law requires hospitals to divulge how much a given payer (insurance company, usually) will pay the hospital, and it also requires carriers to provide access to online cost estimator tools.

Doctors – the second-most-trusted source of cost info – fight giving such info because they rightly point out employees are most interested in their out of pocket costs, not how much the doctor receives.

Hospitals – only trusted for pricing info by 3% (!!!) of consumers – don’t want to give pricing out because each insurer has different discounts and agreements (which seems somehow anti-competitive to me), and hospitals don’t really want people to know just how much money they actually make.  (Hint: It’s a lot!!)

Insurers are required to give info, but they don’t want to divulge their reimbursement levels.  That’s a proprietary, confidential number; they wish to avoid competitors knowing their particular negotiated discount.

And they very successfully hide their cost estimator tool where it’s really hard to find.  Granted, I’m a techno-troglodyte and possess low-end online capability, but I just spent about 30 minutes poking around the BCBS site to find their tool. I never did get there.

I have the option to call Member Services, but I wonder how long I’d be on hold … it hardly seems worth it.

Why Do You Care?

Because a lot of the waste is your company money.  National estimates say one-third of health care costs are completely wasted.  Since the US spends $3.6 TRILLION on health care, that says we’re throwing $1.2 Trillion down the drain.  Average cost for healthcare in the US is about $14,000 per employee, so your firm is currently spending about$4,600 per employee per year you needn’t spend.

At a certain size (roughly 40 employees on the plan) BBI can provide you tools that will help.  Some of our employer clients use Nurse Advisor lines.  Employees can call into a nurse 24/7 to get all kinds of information, including cost info but also including medical guidance and suggestions.

Truthfully, however, utilization on such services is spotty and fairly infrequent.  It’s too much work.  It’s intimidating. Employees might feel stupid for asking, worry about not understanding what the nurse tells them, expect hold times, etc.  So, they don’t call.

Our favorite resource is a tool that gives employees 24/7 access to an Artificial Intelligence service via their smart phones (backed up by live nurses when needed).  They can get referrals, set appointments, find cost and quality input about providers – all automatically.

And when needed, there is nurse follow-up, sometimes when requested; other times the follow-up is a direct outreach from the nurse or the AI software.

It gets much higher utilization because IT’S NOT INTIMIDATING.  It’s easy, and your employee always has his or her smart phone available, so it gets accessed and used.

Cost Alone Isn’t Enough

Therein lies the problem with the Mass requirement.  Cheap isn’t necessarily good, and good isn’t necessarily expensive.  But poor quality is ALWAYS expensive in the end, irrespective of what it costs up front.

What do you and your employee gain if they go to an inexpensive provider who just happens to offer marginal quality or even a quack? So, you need both cost and quality.  We believe what you and your employee want, or should want, is

  • the best possible provider
  • for this specific problem
  • at this specific time, and
  • you want to acquire that service or procedure at the right – not the lowest, but the right – price.

If you could have that for $7-$10 per employee per month (and you can) you would be all but guaranteed to save money on health care.  We have seen ROIs of 3:1 and more with these services.

Is it right for you??  Just ask, we can find a way to make it work.