Price Transparency and Insurance Companies
INTERVIEW ON THE PRICE OF BUSINESS SHOW, MEDIA PARTNER OF THIS SITE.
Recently Kevin Price, Host of the nationally syndicated Price of Business Show, interviewed Dr. David Wilcox.
Health Transparency: The Real Truth with Dr. David Wilcox
None of us would pick up a loaf of bread at the supermarket without first checking the price to see if we could afford it. Most major purchases such as automobiles or houses we negotiate a price and plan our payments appropriately to see if we can afford it. Yet in healthcare, we never know what our procedures, medications and other healthcare items will eventually cost us until we get the final bill. In addition, many Americans are paying insurance companies who have this information and are not willing to share it. It’s an unacceptable model in it’s current state, but all that is about to change!
In July of 2022, the Centers for Medicare and Medicaid Services (CMS) began enforcing rules that require health insurers (payers) to disclose the rates they negotiate with in-network providers and the potential out-of-network amounts patients may owe. On Jan 1st, 2022, we saw legislation passed to require hospitals to provide transparency to the cost of procedures they perform but the fines were so low that many hospitals were initially noncompliant. The CMS raised the fines eventually and began to fine noncompliant hospital systems which increased compliance. With that lesson under their belt the CMS came out swinging hard at insurance companies by fining them $100 a day per patient for each violation. For the largest insurer, United Healthcare who covers 70 million people in the United States that could be a fine as high as 7 billion dollars a day!
OK, so how does this work? Starting in 2023, insurers will be required to disclose the costs of 500 covered services online. In 2024, health insurers must include personalized information for all medical services to all consumers who ask for it.
If healthcare consumers have more information about the price of healthcare services, they will be better informed and should choose the lower-cost options as long as quality outcomes are as good as the higher priced options. This should eventually force higher priced healthcare entities to lower their prices. In addition, introducing more competition and the forces of supply and demand into healthcare could improve quality and the overall healthcare consumer experience. In other words the research that you perform prior to making a major purchase such as a house or car, will be available in the healthcare arena.
There are critics who believe that the information provided will be too complex for the average healthcare consumer to consume. These same critics said this about the hospital transparency laws. Yet when big hospital systems are fined, they become very compliant. These same critics do not want to provide healthcare transparency around costs in an effort to keep everything the same, thus keeping the average healthcare consumer in the dark about their healthcare costs. They also complain that it is resource intensive to provide this information.
Enter the healthcare data translators or “third parties”. Turquoise Health can provide this information to healthcare consumers before they show up for treatment. Consumers use Turquoise Health’s website to shop for healthcare services and research providers for quality of care. To obtain healthcare quality metrics they use machine learning to automate the processing of thousands of payer and provider files containing millions of records. To provide further transparency, Turquoise Health shares its database with referring providers, and employers.
Past history indicates that the health insurers would prefer to keep the costs of healthcare away from the healthcare consumer. If the CMS enforces this new transparency legislation, it will be a game changer and has the potential to drive down healthcare costs for the average healthcare consumer. This disruption in healthcare pricing can only benefit the healthcare consumer willing to do the research prior to accessing the healthcare system.
To keep up with healthcare updates sign up for my newsletter and get a free resource guide. The resource guide is a one click reference to price procedures in your area, find out how your hospital rates for patient experience and quality outcomes, lower high prescription drug prices as well as rate your physician. You can access it here: https://drdavidhelps.com/
You can purchase Dr. David Wilcox’s book How to Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival on Amazon at the following link https://lnkd.in/diZKYC2
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According to a statement, “Healthcare is complex and that is not an accident. It is complex by the healthcare entities vying for your healthcare dollars. Covid has exacerbated the American Healthcare System, which was fragile, to begin with. Many clinicians are leaving healthcare due to burnout. How does the average layperson navigate the complexities of the American Healthcare System where a prescription could cost you $5 at one pharmacy and $500 at another? What does the average layperson do when their insurance company rejects their claim? Proactive education of the American Healthcare System prior to accessing it is the key to safely navigating the healthcare system. Until now, little information has been available to provide the layperson with the knowledge they need to be a better partner in their health care. Dr. David Wilcox’s book How to Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival” is a game-changer and will provide you with the skill set you need to navigate the American Healthcare System.
Dr. Wilcox is a Doctorate prepared nurse who also holds a Masters in Health Administration and is Board Certified in Nursing Informatics. Dr. Wilcox has 28 years of healthcare experience in which he worked as a bedside nurse, hospital administrator, and in healthcare information technology which has helped him to develop his unique perspective on the American Healthcare System.
Dr. Wilcox is the author of the book “How to Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival (2021)” available at https://www.amazon.com/dp/0578878364
Dr. Wilcox currently resides in North Carolina with his wife and their three dogs.
Dr Wilcox’s website: Dr. David Wilcox – Healthcare, American Healthcare System (drdavidwilcox.com)
LISTEN TO THE INTERVIEW IN ITS ENTIRETY HERE