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Could This Pricing Tool For Consumers Disrupt Healthcare?

Written by: Dan Munro

Of all the white hot healthcare topics heading into 2015, none is hotter ‒ or more galvanizing inside the industry ‒ than healthcare pricing. I’m not referring to the cost of insurance coverage (like premiums, deductibles and co‒pays), but the actual cost of healthcare delivery. The kind of pricing that Elisabeth Rosenthal over at the New York Times has covered extensively with her series ‒Paying Til It Hurts. The kind that Steven Brill is eager to showcase on 60 Minutes. The kind that I highlighted last year with a $292,000 bill that was all math and no accounting.

So what and where is this pricing tool? It was unveiled with relatively little fanfare last week by Blue Cross Blue Shield of North Carolina. Why is this disruptive? Because it’s an online tool that the general public can use to compare in-network pricing for specific procedures by provider and location. As an example of what it looks like, here are the in-network costs for a “knee replacement” through two of their more popular plans in a 25 mile radius of Cary, North Carolina.

Clearly it’s not as sexy as many other tools that consumers use for shopping online (and there are lots of disclaimers), but it does represent the dawn of new age in healthcare. Historically, these rates have been a closely guarded secret. They’re often so difficult to negotiate that high profile payers (say Anthem in California and Highmark in Pennsylvania) wind up in pitched battles with equally high profile providers (like Stanford Health and UPMC). When these giants can’t agree on these rates, it’s not uncommon for them to terminate existing agreements (or threaten to) so it’s always been information available to “members only.” That was until last week.

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Josh Sandberg

Josh Sandberg is the President and CEO of Ortho Spine Partners and sits on several company and industry related Boards. He also is the Creator and Editor of OrthoSpineNews.

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