by Jason T. Andrew
When was the last time you ordered food at a restaurant without knowing how much it cost? Would you pay the bill if it were $1,000 instead of the $150 you were expecting? No one enjoys going to buy a used car, where finding out the price is like trying to hit a moving target. Yet this is exactly how our health care system works. We are expected to go to the doctor, get treated, and pay whatever shows up on our bill. There are glimpses of progress in changing this system, and we are hopeful that we will soon be able to predict costs before receiving services. Two recent trends are driving this change: more access to technology and big data, and an emphasis on transparency in use of that data.
Dave Chase CEO of Avado and TechCrunch contributor said, “People are starting to realize that there will be entirely new categories of software that emerge in healthcare representing various facets of disruptive innovation. Given the scale of healthcare ($3 trillion and nearly 20% of the economy), it will put to shame the transformations that happened with shifts from terrestrial to cellular telephony and analog to digital media. The shift from the do more bill more reimbursement model to a value and outcome-based reimbursement model will turn healthcare on its head. Price transparency is just one of the first examples of many.”
Despite the ACA and technological innovations, 10 years after HSAs were introduced, only 30% of HSA account holders passed a basic HSA proficiency quiz, according to a recent study released by Alegeus Technologies.
In addition, a solid understanding of out-of-pocket costs is still elusive.
A recent study at UC San Francisco and California Health Care Foundation revealed colossal price disparities. For example, in California, the world’s eighth largest economy, the cost of a routine appendectomy ranged from $1,529 to a high of nearly $183,000 for the exact same procedure.
San Francisco-based Castlight recently garnered tremendous attention for closing $100 million in funding and going IPO with close to a $1 billion valuation. The company is working to bring price transparency and comparison tools to healthcare. Hopefully, it will open the pathway for others to help provide greater insight and solutions to this problem. But we don’t see this happening anytime soon.
Despite the problems, demand has continued to grow for consumer driven health plans (higher deductibles). Forrester views adoption of CDH plans as stronger than predicted — showing HSAs as the growth engine. America’s Health Insurance Plans just released a study saying 17.4 million Americans are covered by HSAs, which is a 13% increase from last year.
So what do we do with all this information? How do we make rational, logical and economical decisions without the proper tools to help us? With the increased complexity of ACA, benefit advisers and other professionals need to find ways to evolve and remain competitive. There is a growing need for innovative tools to improve employees’ understanding about their health care plans and choices. Here are a few interesting consumer-facing tools:
• GoodRx (www.goodrx.com) — a tool to understand and compare costs of prescription drugs.
• HealthCare Blue Book (www.healthcarebluebook.com) — a consumer tool for estimating cost of care.
• Simplee (www.simplee.com) and Cake Health (cake.com) — a tool to pull claims data from your health plan. It allows you to pay doctors.
• HealthCPA (www.healthcpa.com) — a health concierge for group and individual benefits.
While useful, these tools still don’t help us figure out the best option for selecting and interacting with the healthcare system. When evaluating a standard plan versus an HSA compatible plan, how do you model and present it to your employer clients? Once your client makes a decision, how do you communicate this change to employees who don’t understand the technical aspects of pre-tax, consumer driven, high deductible, investment accounts? Or consider the fact that most consumers are not prepared to engage the healthcare system and ask their doctor about costs or negotiate when they are used to paying a co-pay when going to their doctor.
I have seen some inventive tools popping up. What have you found that has been truly valuable in helping you make intelligent, precise decisions? How are you helping your clients understand their options in a more and more complex environment? Finding tools and technology solutions is essential to serving your clients, and will become increasingly important in streamlining your business and helping it grow.
Jason Andrew is co-founder and CEO of Limelight Health. With offices in Silicon Valley and Redding, Limelight Health provides innovative cloud-based products to insurance agents. Previously, Jason was the founder of stone Meadow Benefits & Insurance Associates, a silicon Valley-based insurance brokerage. Prior to founding sMB, Andrew worked as the managing producer at Lawson-Hawks Insurance Associates. He serves on the Board of Napa Children’s Health Initiative. He also serves as an advisor to GoVoluntr, a startup that connects volunteers, non-profits and businesses together. Previously he was on the Silicon Valley Association of Health Underwriters Board of Directors and led a committee for the California Association of Health Underwriters. Andrew served for seven years as a minister for the International Churches of Christ and holds a degree in communications from Lewis and Clark College.