Revealing Value: Price Transparency in Healthcare Recap

September 16, 2021
Josie Rasberry

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We were happy to partner with the Accountable Care Learning Collaborative to host the Revealing Value: Price Transparency in Healthcare Webinar to discuss hospital price transparency with our CEO, Matt Dale, and Marshall Allen, author of “Never Pay the First Bill." If you missed it, you can listen to the whole thing below for free or you can read highlights from the webinar below!

You can also take deep-dive into price transparency by reading the ACLC’s Revealing Value: Hospital Price Transparency Brief here.

Dr. Eric Weaver: “We have a broken system. We’ve all seen the stats. Healthcare debt is the number one cause of personal bankruptcies in our country. Mandating price transparency is really an important policy lever in slowing down some of the cost increases because it impacts real people. Real families. So to open up our first question, how has the lack of pricing transparency impacted patients and their families? What are the kinds of stories of medical debt you’ve seen?”


Marshall Allen: “You can’t overstate how bad the lack of transparency is for the American public. It’s a crisis. 1 in 5 Americans has medical debt in collections right now. The problem is not that we aren’t spending enough, it’s that we are spending way more money than we should. On the micro-level, I heard this story at a conference: a woman was charged $15,000 for a colonoscopy, and Medicare would normally pay $1,000 - 2,000 for that. You don’t see the price upfront, so she didn’t know what it would cost her until it was too late. The doctor’s solution? A 10-year payment plan. It’s an unfair, unjust, unethical, immoral situation in healthcare right now.”

Matt Dale: “The problem that you’re describing isn’t isolated to one condition or one part of the country, it’s something that happens all over the place in America. It's fairly common for us to see $5-10,000 bills for emergency room visits where a patient saw a doctor for maybe 15 minutes or less. We had one patient that needed rotator cuff surgery. He called his insurance company to see where he should go and they said his local hospital. He had a defined benefit plan where no matter where he went his insurance was going to pay $5,000 towards the cost of his surgery. Well, the local hospital wanted to charge him $68,000, so he was going to owe $63,000. That’s a life sentence. You’re going to be paying that off for the rest of your life. Now, where transparency comes into play in this story is that there was a surgery center 15 minutes from this guy’s house willing to do the whole procedure for $8,000. One of the big challenges the system has is that you shouldn’t have to be an expert to know there’s a facility that will do your procedure for $8,000 and the hospital will do it for $68,000. That’s just one way price transparency can make a world of difference.”

Dr. Eric Weaver: “So Hospital Price Transparency exists so consumers can have more value-oriented decisions about their care. There's supposed to be pricing on 300 shoppable services, like CTs, MRIs, blood tests, and other elective procedures. But hospitals fought this kicking and screaming but it is in effect, and I just wanted to ask you both: How is this going to have a positive impact on pricing since patients have better estimates in hand and can make better choices? And also, are we going to see maybe competition on pricing between hospitals or downward market pressure on pricing?”

Marshall Allen: “This price transparency rule is a gamechanger. Many hospitals are flagrantly ignoring the rule, but having the prices available to consumers is huge... Right now we are in the early stages where people are just starting to learn that if they are motivated, they can use this information to find a fair deal on the front end and fight a bad deal on the back end. And it’s only going to get more powerful so that we can leverage it more and more to get a fair deal down the road.” 

Matt Dale: “Even though all of the hospitals aren’t in compliance, they will get in compliance eventually. It is economics 101. Once you put transparency out there, the hospital that isn’t complying isn’t going to get business. If certain hospitals are showing their pricing and getting business, then other hospitals will be forced to comply as well.”


These are just snippets of the great conversation between Eric, Marshall, and Matt, so if you want to hear more about price transparency and healthcare costs, check out our Price Transparency Brief Summary!

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Discover what health plan members had to say about the value of patient advocacy in our survey.

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