The Future of Transparency: Can Data Fix Health Care? [Part 5]

It’s time for the final part of our series of blog posts recapping a recent BenefitsPro and Artemis Health webinar. The webcast “The Future of Transparency: Can Data Fix Health Care?” featured panelists included Jim Blachek, co-founder and principal at the Benefits Group; Lester Morales, CEO of Next Impact; and David Contorno, founder and CEO of E Powered Benefits. Eric Silverman, founder of Voluntary Disruption, moderated. Slides and audio are available on-demand. 

This week, the panelists take questions from the audience and share final thoughts on the role of brokers and consultants in benefits data analytics and healthcare. 

Eric Silverman: So Paul, did you want to ask any of these questions to the panelists here for me that you might have been able to select? We have quite a few that came in here.

Paul Wilson: Yeah, I was going to say, we've had a ton come in, so thank you everybody who's listening in for sending in your questions. I'm going to throw a few of these are directed at individual people, but otherwise I'm going to throw them out and let you guys decide who wants to answer them.

You guys touched on the stuff out of Washington, D.C. and the legislative angle of a lot of this, but somebody wanted to ask, “How do you expect the president's latest executive order, for hospitals to provide transparent data, to impact this space? Will it help HR and benefits professionals improve clinical outcomes and bend the cost curve?”

So David, I mean I know that you were kind of a skeptic, so do you want to kick it off?

David Contorno: Back to what I said earlier, I don't believe the fix to this is going to come from the government. What we desperately need is an improvement in quality, and a decrease in cost, and I can't find one example of something our government has taken over which that has occurred.

The reason I'm hesitant about this bill is...and I've read the bill I was part of the committee that helped form it and write it. I was behind this bill and helped in many ways craft it, but when it actually gets to the floor of the Senate and the House after the lobbyists and the Senators and Congresspeople have gone through it, it changes.

And one of the things that I'm worried about is it says in there that hospitals must disclose a price. Now, here's the problem. What price are they going to disclose? Are they going to disclose their cost? Are they going to disclose what Medicare would pay them, what Medicaid would pay them? What they get on the Blue Cross National PPO or maybe the Blue Cross local PPO, or maybe the Blue Cross local HMO? Or maybe it's the United Choice Plus network, or maybe it's the United Heritage Valley, or maybe it's some other carrier. The point is, every hospital probably has 30 to 100 different prices for the exact same thing.

Which of those prices are they going to publish, because if it's not the price that I'm going to pay, then I don't care. I don't know how they would possibly post the price that I'm going to pay if I'm going through a traditional plan in which the prices are not only variable, but do you want to know the one thing that has the biggest impact on price? It's the doctor's pen. It's how they code that claim, which doesn't occur until after the services are rendered. That drives the price more than anything.

Everyone makes this so complicated. What I think needs to happen, and the way the law should have been worded is to say, except in an emergency, which by the way is only 4% of care or less, the hospital must provide an up-front, binding price.

It can be any price they want. I don't want to get involved in setting the price, I just want them to have to give an up-front, binding price like every other business in this country has to do. You don't get an estimate of your TV from Best Buy and then find out the exact price when you're driving it home. You get the exact price before you buy it. And that's what we need.

Paul Wilson: One person was asking what strategies have you guys seen fellow advisors using as far as using transparency as a growth strategy? In other words, obviously there's a lot of places where this can help the employers your clients, but how have you guys seen it impacting the growth strategies of the advisors themselves using transparency?

Lester Morales: I'll take that and obviously the other two folks on this talk are advisors and can talk about their own growth, but I work with advisors across the country. And I would tell you in no way shape or form is adding this, I'm not even going to say as part of your spiel, I'm going to say as the main point of your spiel, in no way shape or form can this hurt.

Clients at the end of the day will choose how much they want to take on and where they are in the continuum. You have to meet a client where they are, but the acknowledgement that you understand the system is broken and that you're trying to be part of the fix, and the fact that they're overpaying for claims versus what Medicare reimburses that same facility for the same number, and that their employees are going to lower quality, high-cost places.

The acknowledgement of that, the education of that, in no way shape or form is ever going to hurt. Even getting quotes and proposals for plans that you might not necessarily be ready to implement is only going to allow you to have negotiation leverage with the status quo.

I am mind boggled by the amount of advisors who sit on these calls, who talk all the talk, and then at the end of the day when you ask them how many clients are doing anything that we're talking about the number is, you can count it on one finger or less.

I would say that how this impacts growth...clients want to be educated. They want to be with advisors that are sitting on their side of the table, so compensations like the one David hit before—educating them and exposing them to the new things that are out there—and making it known that these are the case. What clients aren't going to want to hear something that is actually delivering change. I just don't understand how and why it has taken so much time for the adoption right here, when it can only help.

Eric Silverman: That's a great point. I think this is a great one. I wanted to see if Jim could chime in on and maybe wrap it up. “Has it been proven through the data that higher quality drives lower cost?”

Jim Blachek: Honestly, all that data in those slides, that's coming from the center of Medicare and Medicaid services data. We're able to pull that data and those slides, and I know that data that Six Degrees uses is all governmental data. These aren’t things that we're just cherry picking, and it's usually 9 times out of 10 that the highest quality facility or physician or those services have the lowest cost. 

Is it every time? No. But it's a preponderance of the time so that yes, higher quality does end up with a lower cost. And that's why we push towards quality and not cost, because ultimately the higher the quality, the lower the cost.

Paul Wilson: All right. Several different people have been asking basically they're interested in all of this, but it's intimidating, there's a lot to learn. Where would you guys recommend they could turn if there's somebody who was interested in getting into this world or starting to move their practice in this direction. What are some sources that they can reach out to, to kind of get advice and help?

David Contorno: I'll throw a couple of quick answers out there. Some of these are organizations that I'm part of, but one is Health Rosetta. I think is a non-profit organization that's cultivating and validating the strategies, and then putting them together to make them more effective in creating a framework for what a transparent, high-value plan looks like. I don't receive any compensation for Health Rosetta or for what I'm about to say, so I don't want anyone to think that's the case, but I helped Dr. Tom Scott create a master's level certification and benefit design in healthcare financing. There's not a single other course out there like it, it doesn't exist, and it's done through Lynchburg University, it's an accredited master's course. Get your master's degree in this, so that's another.

And then there's tons of books out there. There's An American Sickness, America's Bitter Pill, and The CEO's Guide to Restoring the American Dream. There are books out there that can help you highlight, but what I would challenge everyone to understand first is not the solution. That's second. 

What I find most people don't truly understand is the problems with our existing system, and I think you need to understand the problems first to be able to understand the solutions, and why they work to be able to accurately convey them to your client.

Paul Wilson: That's a great answer. I think that's a great place to wrap up. I would like to thank everybody for joining us today, and we really hope it was valuable to everybody. A special thanks to all of our speakers for their time and their great insights today, and again thanks to Artemis Health for their support.

That’s a wrap on our five-part series with BenefitsPro, “Can data fix healthcare?” We hope you found the discussion to be valuable and helpful in understanding the role of benefits data in shaping the future of healthcare.