Medical Cost Reduction

Medical Bill Problems Steady for U.S. Families, 2007-2010

Doug 1 Comment

Troubling stats indicate 20% of Americans are still having difficulty paying medical bills.

By Anna Sommers and Peter J. Cunningham

More than one in five Americans were in families reporting problems paying medical bills in 2010—about the same proportion as in 2007,according to a new national study by the Center for Studying Health System Change (HSC).
Given the severe 2007-09 recession, the sluggish economic recovery and health care costs continuing to increase faster than incomes, it is somewhat surprising that the rate of medical bill problems did not increase between 2007 and 2010.
The steady rate of medical bill problems may be a byproduct of decreased use of medical care—both by people who lost jobs and health insurance during the recession and others who cut back on medical care in the face of uncertain economictimes. While problems paying medical bills stabilized in recent years, the proportion of Americans in families with medical bill problems remained significantly higher in 2010 compared with 2003—20.9 percent vs. 15.1 percent. And, in 2010, many people in families with problems paying medical bills continued to experience severe financial consequences, with about two-thirds reporting problems paying for other necessities and a quarter considering bankruptcy.

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The Future of U.S. Health Care

Doug

What Is a Hospital? An Insurer? Even a Doctor? All the Lines in the Industry Are Starting to Blur.

By ANNA WILDE MATHEWS

Call it the united state of health care.

Amid enormous pressure to cut costs, improve care and prepare for changes tied to the federal health-care overhaul, major players in the industry are staking out new ground, often blurring the lines between businesses that have traditionally been separate.

Hospitals are bulking up into huge systems, merging with one another and building extensive new doctor work forces. They are exploring insurance-like setups, including direct approaches to employers that cut out the health-plan middleman.

On the other side, insurers are buying health-care providers, or seeking to work with them on new cooperative deals and payment models that share the risks of health coverage. And employers are starting to take a far more active role in their workers’ care.

Such shifts have been gathering force for a while, but the economic downturn has accelerated the push for efficiency. The federal legislation, which creates new health-insurance marketplaces and requires most people to carry coverage, may unleash additional demand for health care once it fully takes effect in 2014. Even if the Supreme Court unwinds part of the law, the changes occurring now aren’t likely to stop because the pressure to reduce the price of health coverage won’t go away.

It Has All Been Tried Before, Experts Warn
(more…)

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Aetna sues 9 N.J. doctors for “unconscionable” fees

J Roberts

Lawsuits claim that the out-of-network physicians charged as much as $50,000 for an inpatient consultation.

By Alicia Gallegos,

American Medical News

Aetna Inc. has accused nine New Jersey doctors of charging excessive fees for out-of-network services. Four are countersuing, alleging that the insurer is guilty of fraudulent billing practices.

The lawsuits are the latest development in a debate among insurers and health care professionals over “usual, customary and reasonable” rates for out-of-network doctors.

Aetna sued the physicians between July and November 2010, claiming that they had charged “unconscionable” fees for services and threatened to balance-bill patients if not paid.

Cardiologist Benjamin Hannallah, MD, of Watchung, N.J., charged up to $48,980 for an inpatient consultation in 2009, an increase of more than $47,000 from his 2007 rate, according to one of the lawsuits. The average Medicare charge for an inpatient consultation is $358.12, according to 2010 data from the Centers for Medicare & Medicaid Services.

Cardiologist Karan Nejad, MD, of Hackensack, N.J., raised his fee for seeing critically ill hospital patients from $2,040 in 2007 to $15,000 in 2008, another lawsuit claims. The average charge for the first hour of a critical care visit is $520.76, according to CMS data.

Gynecologist-obstetrician Waleed Abdelghani, MD, of Hackensack, who assisted in two cesarean sections, allegedly charged $30,000 for each surgery, while in-network surgeons were paid about $2,000 for the same procedure, Aetna said. Standard pay for a surgeon assisting a C-section is $1,400, Aetna spokeswoman Cynthia Michener said.

“These were just outrageous bills,” she said. “We are hoping to develop some case law here that there is such a thing as an outrageous fee.”

The sued physicians treated patients at hospitals in Aetna’s network. The patients had no knowledge they were being treated by out-of-network doctors, Michener said.

Attorneys for the doctors denied Aetna’s allegations and maintained the fee rates were reasonable. Aetna has taken the charges out of context and made much of simple clerical errors, said Robert J. Conroy, attorney for Drs. Hannallah and Nejad.

“Their case is built on half-truths, innuendo and omissions of material facts,” he said.

Aetna is attempting to establish regulations on out-of-network fees through the courts because of its failure to do so legislatively, said George Frino, attorney for interventional cardiologist Deepak Srinivasan, MD, of Hackensack, one of the defendants.

“[Dr. Srinivasan] was shocked and appalled that an insurance carrier would claim fraudulent billing activities when, for years, his invoices were processed in due course, and no complaint was ever made by Aetna,” Frino said. “In our mind, this is a gross misuse and abuse of the judicial system.”

Between November 2010 and March, four physicians, including Dr. Srinivasan, countersued Aetna. They allege deceptive billing practices and racketeering, among other claims. Aetna denies the allegations and has asked a judge to dismiss the suits.

Most out-of-network physicians practice fair billing, Michener said. Only a handful take financial advantage of hospital patients, she said.

Aetna plans to review similar billing patterns in other states to identify doctors who are potentially billing excessively.

“Some doctors who used to be in-network realized they could go out-of-network and raise fees because they had a captive patient base in the hospital,” she said.

Billing system at odds

Insurers and physicians have fought in court elsewhere over acceptable UCR rates.

In 2000, the Litigation Center of the American Medical Association and State Medical Societies sued Aetna, UnitedHealth Group and several others over a database used to determine fees for out-of-network care. The Litigation Center said the system for years had been using flawed data to set the rates.

The suits triggered an investigation by Andrew Cuomo, then New York attorney general. In 2009, UnitedHealth Group reached a $350 million settlement.

As part of a separate settlement with Cuomo’s office, large health insurers operating in New York agreed to stop using the data. None of the companies that settled admitted wrongdoing. Cases against Aetna, Cigna and WellPoint are pending.

Ingenix, a subsidiary of UnitedHealth Group, which sold the database at the center of the Cuomo agreements, is now known as OptumInsight.

A database created by FAIR Health, an independent nonprofit, was launched in January. Database officials expect to send payments based on the new figures to physicians by the summer.

American Medical Association President Cecil B. Wilson, MD, said the AMA supports more transparency in the out-of-network billing system.

“The AMA does not condone excessive fees for medical care and encourages physicians and patients to discuss costs before medical services are provided,” he said.

Also named in Aetna’s lawsuits are: internist Magdy Wahba, MD, of Paterson, N.J.; neurological surgeons, David Estin, MD, Jonathan Lustgarten, MD, and Ty James Olson, MD, all of Ridgewood, N.J.; and obstetrician-gynecologist Azer Alizade, MD, of Hackensack, N.J. Aetna also listed several “John Does” in the suits to allow for more defendants if their involvement later becomes clear.

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NJ lawmakers seeking to control insurance costs

J Roberts

Looking for greater transparency on how insurers calculate and charge for premiums? The state of NJ is intending to provide just that. A recent measure adopted by the state legislature would require all insurers to gain approval by the state’s regulatory agency before they can raise premiums.

THE ASSOCIATED PRESS

TRENTON  — Health insurance carriers who serve individuals and small businesses in New Jersey may soon have to gain state approval before implementing rate increases.

These firms currently can set and increase rates just by filing the information with the state. But a measure planned by three state lawmakers would require that the firms gain approval for such actions from the state Department of Banking and Insurance.

It also would expand the jurisdiction of the state’s Division of Rate Counsel, which now has no say over health insurance rates, to create a watchdog for residents and small businesses.

“Residents deserve a watchdog, someone with the knowledge to advocate on their behalf when it comes to the complicated issue of rising health care premiums,” said Assemblyman Dan Benson, D-Hamilton Township (Mercer County), who said he will sponsor the measure with fellow Democrat Valerie Vainieri Huttle of Englewood.

Democratic Senate Majority Leader Barbara Buono plans to sponsor identical legislation, with both measures likely to be introduced by year’s end.

“This legislation will provide far greater transparency,” Benson said.

Ed Rogan, spokesman for the banking and insurance department, declined to comment on the proposal. As a matter of policy, the department does not discuss proposed or pending legislation.

Besides requiring the banking and insurance department commissioner to approve any rate increase, the proposed bill also would give the commissioner authority to reject proposed rate changes deemed discriminatory or excessive.

The commissioner and rate counsel would also have to jointly hold public hearings on any proposed premium increases for insurance contracts or policies in the Individual Health Coverage Program or New Jersey Small Employers Health Benefits Program market.

Information about premium increases, including an explanation of how carriers report and calculate health insurance premiums, also would have to be posted on the department’s website.

Currently, insurers in these plans are required to spend no more than 20 percent of the premiums paid on administrative expenses.

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Sixteen percent of Americans unable to pay medical bills, according to Consumer Reports’ Trouble Tracker Index

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Medical Cost Advocate recently appeared in the September issue of Consumer Reports. One of the key points of this article is the assertion that consumers should line up a medical billing advocate or their own alternatives proactively. Don’t wait until its too late to do your research and find a health care negotiator.

Consumer Reports: How to Haggle With Your Doctor or Hospital

YONKERS, NY — When we visit our doctors, we don’t typically think of ourselves as “consumers” or buyers of health care, but in these tough times, that is precisely the role a patient needs to play to avoid drowning in a sea of medical bills. What are the best strategies for haggling with your doctor or hospital? A new report in the October issue of Consumer Reports and online at www.ConsumerReportsHealth.org features advice from Consumer Reports’ medical expert and M.D., John Santa.

According to the latest Consumer Reports Index, which gauges the health of the economy from the consumer perspective, 16.3 percent of Americans are unable to afford medical bills.

“Americans are overwhelmed by health costs and many people simply can’t pay their bills, can’t afford their medications,” says John Santa, M.D., M.P.H., director of the Consumer Reports Health Ratings Center. “The last thing most patients want to do is haggle with their doctors, but a little bit of negotiating can go a long way. It’s also important to know that there are tremendous variations in health care costs—knowing this can help a consumer get a hand up and politely insist on the fairest possible price.”

Here’s Consumer Reports’ advice for three possible scenarios:

You’re healthy.The optimal time for patients to talk with their healthcare providers about costs is before any have been incurred. While doctors have a professional obligation to take a patient’s financial resources into account, patients should raise the issue with their doctors to let them know that costs are important to them. “For a variety of reasons, doctors are likely to suggest the most expensive options first. But you might be surprised by your doctor’s willingness to change course, for example prescribing fewer expensive brand name drugs or choosing watchful waiting over a costly diagnostic test,” says Santa.

The unexpected occurs. A patient lands in the hospital without the benefit of any planning and gets slammed with a huge bill, say $15,000 for a coronary angiogram, and insurance ends up covering only a fraction of the bill. Consumer Reports recommends these approaches to get the greatest reduction to their bill:

  • Sit down with the doctor who ordered or performed the hospital services to find out how the hospital costs ran so high. Were all the services needed and reasonably priced? Consumers can judge for themselves by checking www.healthcarebluebook.com which lists the going rates for many medical services for free. Closely examine each bill to identify errors, which are common.
  • Consumers should not assume the price on their bill is set in stone. Providers often discount rates substantially to insurers and others, so why shouldn’t a consumer ask for the same rate reduction? Consumers should dispute any charges they think their insurance company ought to cover.
  • Patients should not pay their bill until they have exhausted all of their options, but they should make clear to the hospital’s billing department that reaching a resolution is important to them. They might consider making a discounted offer they think would be manageable within a set time period. Consumers can consult one of the reputable groups that, for a fee, can help reduce the size of medical bills, such as Medical Cost Advocate (localhost/wp1).

You’re having an elective surgery. This situation allows for more planning and research into the best procedure, doctor, hospital, drug or other option. “Use your time wisely to do the research because variations in health-care costs can be significant, and providers will gladly let you overpay for a service that you could get for less,” says Santa. Keep in mind the following advice:

  • Consumers should shop around, talk to different providers, and bargain for what they think is a fair price.
  • Consumers shouldn’t hesitate to ask for the price upfront and get it in writing. Request an itemized list of all potential charges.
  • As with any purchase, consumers should beware of any offer that sounds too good to be true. If a provider suggests a shortcut, be wary and ask a lot of questions, and check out providers that are unfamiliar.

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How the seemingly largest hospital bill came to be

J Roberts

Read about the world’s largest healthcare bill.

By Karen M. Cheung

It may be the largest hospital bill ever. Estimated at $9.2 million, including interest, the bill is from Tampa (Fla.) General Hospital for the care of deceased Tameka Jaqway Campwell.

Although the American Hospital Association, the Health Care Financial Management Association, and even the Guinness Book of Records couldn’t confirm the highest hospital bill in history, according to Associated Press (AP), the $9.2 million in charges for one patient certainly draws questions into high healthcare costs and end-of-life decision making.

Campwell had an incurable disease, progressive demyelinating neuropathy. The patient’s mother Holly Bennett accused the hospital of not feeding her daughter and giving her too much morphine, which, she claimed, resulted in the patient’s weight falling to 37 pounds, reports the AP. Campwell died two years ago.

The hospital is suing the patient’s estate for the outstanding bill.

“If they think they’re getting money from me, they’re crazy,” Bennett said in the article. “Who’s ever even heard of a bill that high?”

Although the hospital charges will likely drop to $2.25 million after readjustments, Bennett told ABC News she would not pay the multimillion-dollar bill. She said that she never received an itemized bill during the five years of treatment and that the lawsuit is a strategy to prevent her from filing her own lawsuit for medical malpractice against the hospital.

A frequent complaint from patients and providers alike, patients often do not understand the associated costs for tests and care with no clear prices for services.

“This is tragic,” said Alan Sager, a professor of health policy and management at Boston University School of Public Health, in the ABC article. “A patient apparently received costly care that might have made her more comfortable–and might have slowed the progression of her illness, but these interventions apparently could do little more than slow a steep decline.”

Hospital palliative care has doubled in the past decade, ranking as one of the fastest growing specialties with 63 percent of U.S. hospitals using palliative programs. According to a Center to Advance Palliative Care report this month, there are 1,568 palliative teams at nationwide hospitals, up from just 658 in 2000.

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Cut Costs by Reducing Redundant or Inefficient Activity

J Roberts

What’s the parallel between the world’s largest car manufacturer -Toyota – and the American Healthcare System?  Read on to learn how total quality management and improved operational efficiencies can reduce waste and decrease spending in our healthcare system.

By Mark Graban and Rob Harding August 09, 2011

Enlist your employees to help find and eliminate waste in your organization’s processes.

Many hospital CEOs, including John Toussaint, M.D., the former CEO of ThedaCare, and thought leaders, including Donald Berwick, M.D., M.P.P., administrator for the Centers for Medicare & Medicaid Services, estimate that 30 to 50 percent of all health care spending can be described as waste — activity that provides no benefit to patients. This adds up to more than $1 trillion a year in the United States. Instead of merely slashing reimbursements or providing less care, there is a clear opportunity to do more — and provide the right care — with less waste and less spending.

The word “waste,” or muda in Japanese, is one of the most commonly used terms in Lean management, which is based on the Toyota Production System. According to Toyota, there are eight types of waste, each of which can be translated directly into health care:

Lean’s Eight Types of Waste

Examples of Waste Found in Hospitals

Defects

Lost or mislabeled laboratory specimens

 

Overproduction

Medications sent to inpatient units in 24-hour batches, leading to wasted medications if orders

Change

Transportation

Moving patients a long distance from the operating room to recovery

Waiting

Patients waiting weeks for an appointment, or waiting hours to be seen in the emergency department, resulting in exacerbated conditions

Inventory

Expired supplies due to overstocking and poor rotation of inventory

Motion

Staff walking in excess because high-use surgical instruments and packs are not grouped together in perioperative services

Processing

Staff writing or entering the same patient information into multiple forms or software screens

Human potential

Nurses dragging bags of dirty linen down the hallway; staff members unengaged in improvement activities

In health care, Lean teaches us to engage all staff members in a never-ending search for waste, making quality and process improvements that benefit patients, leading to lower costs. Reducing waste is very different, in mindset and practice, from traditional cost cutting, as Lean waste reduction looks at how the actual work is performed rather than focusing on spreadsheets, budgets and financial benchmarks. Reducing errors, improving throughput, reducing staff frustration — all of these tactics reduce costs.

A Lean Perspective on Waste

Traditional organizations might see that 60 percent or 70 percent of their expense is direct labor cost. This realization often leads to the idea that the clearest path to cost reduction is to eliminate people (again, often based on benchmarks). Lean methodology takes a different view: Waste reduction cannot be used to drive layoffs, as that would put an end to staff engagement in the improvement process — a core Lean principle.

Leading health care organizations that actively employ Lean tactics, including ThedaCare, Denver Health and Avera McKennan, all have “no layoffs due to Lean” commitments with employees. Engaging people to reduce waste through process improvement has led to significant savings at these organizations — more than $54 million at Denver Health, for example — along with quality and access improvement, thanks to a culture of collaboration. (more…)

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Insurance mandates again hike costs

J Roberts

Recent government mandates in the state of Connecticut raise the cost of insurance for all. While the act aims to offer more comprehensive services, it may, in actuality prove as a disservice by raising the overall cost of insurance to the states residents.  Read on to learn more.

By Greg Bordonaro

While tax increases, paid sick leave and union concessions took up most of the attention during the recent legislative session, lawmakers passed a flurry of new health insurance mandates that will raise the cost health insurance for employers.

In all, seven new mandates — some of which business lobbyists have fought for years — passed the legislature and have been signed into law by Gov. Dannel P. Malloy.

A health insurance “mandate” is something for which an insurance company or health plan must offer coverage, and whose costs typically get passed onto employers.

Health mandates have been a hot political issue in Connecticut for years. The business community has long voiced opposition, citing costs. But supporters say cost concerns are overblown and that the benefits outweigh the price.

The divide illustrates a central issue in the broader health care debate. The question of how to control health care costs, while also mandating adequate coverage that prevents and treats illnesses effectively, has been difficult to answer.

New mandates passed this year:

• Expand coverage requirements for certain patient clinical trials, breast MRIs, colonoscopies and prostate cancer screenings;

• Increase the maximum annual coverage for ostomy-related supplies from $1,000 to $2,500;

• Require coverage for bone marrow testing;

• And place new restrictions on insurance companies that require the initial use of over-the-counter drugs for pain treatment.

“It is a fundamental truth that as you add benefits you increase costs,” said Keith Stover, a lobbyist for the state’s health insurance industry. “The math isn’t that complicated.”

According to a report by the Council for Affordable Health Insurance (CAHI), which is funded by the insurance industry, Connecticut had 59 mandates at the end of 2010, making it the fifth most demanding state.

While mandates make health insurance more comprehensive, they also make it more expensive, requiring insurers to pay for care patients previously funded out of their own pocket. Those expenses often get passed onto employers through higher premiums.

(more…)

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Employee wellness programs help companies deal with rising healthcare costs

J Roberts

One way corporate America is tackling the rise in healthcare costs is by offering an employee wellness program.  Many are offering incentives to employees in terms of gifts and rewards for employees who become actively engaged. The benefits are worth the investment as employers are encouraging employees to take an active role in maintaining their health.

KePRO Industry News

Many employers’ healthcare costs are soaring as a result of the high prevalence of chronic diseases. This is cutting into profit margins and making it difficult for companies to expand. In order to address the situation, many businesses are looking to employee wellness programs.

For example, a group of business leaders in Oregon and state health officials recently joined forces to form the initiative Wellness@Work, according to Oregon Business. The project provides companies with an online resource that they can use gauge their employees’ levels of wellness and consider new initiatives to improve well-being.

“We’re hoping businesses will bring together a committee of employees from all departments to make changes to their workplaces,” Dawn Robbins, the state’s worksite wellness coordinator, told the news source.

She added that despite fears over the cost of the initiatives, most businesses see a significant return on their investment in employee wellness. In fact, the Wellness Council of America estimates that most will experience a return of $3 for every $1 invested.

This could help businesses handle the dramatic rise in healthcare costs that are expected to occur this year and beyond.

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Be Prepared!

J Roberts

Be Prepared…Your House or Your Health? Today health care is everywhere — in the CEOs office and around the kitchen table. Five years ago it was in neither place. Does this mean that consumers are prepared for the tsunami of health care change coming? This article by our friends at Allexian Consulting describes some very real issues and some innovative models emerging to help consumers.

James D. Calver

Allexian LLC

Be Prepared!

The average consumer, Joe or Jane, age 25 or older, makes $32,000 per year, does not have a college degree, drives a car, lives in his or her own home, and holds a white-collar office job. They can tell you their grocery bill, the price and quality of food, their car price and monthly payment, their mortgage payment and house value. Ask Joe or Jane how much their health care costs —  the cost of treatments, the cost and quality of their plan, are they getting a fair price and you’ll get a blank stare.

In 2014 Joe and Jane are going to be hit by a health care tsunami. The average mortgage payment today is $700/month with $1000 of annual home maintenance on top of that. The price of health care for many families will exceed the cost of owning a home and become the biggest single expense a family has each year.

Consumers are unprepared.

For 50 years consumers have outsourced their health care. Employers chose employee health care plans and (mostly) paid for them. Physicians treated disease conditions paternalistically. Payers administered plans and guided consumer choice of their physicians.

Consumers need to in-source their care and take control.

The numbers are big. Between now and 2014, 30 million new consumers will be coming to terms with new health care programs. Surveys show that many employers will scrap their own health care plans and “dump” their employees into exchanges. The total number of consumers dealing with health care change will be far bigger than the 30 million from last year’s reform. We estimate that this will be north of 40 million consumers.

What does in-sourcing health care mean? It means taking control of all the key decisions of your own heal care. Choosing a plan, checking prices of treatments, being sure you’re getting a fair price, etc. Consumers need tools and information to manage their health care decisions.

What tools? What information? To answer these questions it is useful to compare other more familiar buying decisions — groceries and homes. When we buy groceries, we want to know the price in advance of getting to check out. We want to know the quality too. When we buy a house, we want to know the quality and price of the house, the cost of the mortgage, how much the utilities and taxes are and the general condition of the neighborhood. We also want to know how much ‘house’ we can afford and if we are getting a fair price. We get help from brokers in negotiating a fair price and get comparable house prices from Zillow and other rersources.

Buying health care isn’t exactly like buying groceries, nor is it exactly like buying a house. But it is has much in common with the two together. When you buy a health care plan, you want to know the cost and quality of the plan. You have to find a physician, you’d like to know the quality of the physician, patient experiences and quality of care. Some patients like to research their disease conditions. You want to know how much treatment is going to cost and if you’re getting a fair price (before you get to check out). You may want help negotiating a price for a big clinical treatment or procedure.

Some of these tools and information are available already. New growth business models are emerging.

Buying a Health Plan — Exchanges

Individual states will either run the exchanges themselves or outsource to a third party. Exchange businesses can charge a modest fee for operating the service that matches a consumer with a health care plan.  eHealthInsurance is a broker of health care plans. They advertise low plan rates and based on input from the consumer recommend a plan and estimate of monthly payment. From personal experience, this payment and what the health insurers eventually charge can be much higher — this is explained in the small print.

While coverage cannot be denied for pre-existing conditions, the insurers have latitude to charge more in monthly premiums for these conditions. The unwary consumer is in for some nasty surprises.

We recommend that exchanges use crowd-sourcing technology, in the style of Angie’s List, Amazon and eBay to provide reviews and feedback on plans. This information will help consumers make better and more informed decisions.

Researching a Disease

The availability of clinical information has undergone a tectonic shift. For the first time since the medicine men of old began treating ailments, all medical knowledge is available today via the web to a consumer. That shift contributes to the drive away from paternalistic clinical practice. Enlightened consumers of care use WebMD, Mayo, Cleveland Clinic and many others to research diseases and treatments.

Today 30% of consumers visit a medical web site before visiting a physician. That number is trending upwards annually. We think that creating a consumer pay model here will be difficult. For over a decade consumers have not paid directly for access to this information and we don’t think that will change.

Researching Physician Quality of Care and Patient Experience

The best physician web information services focus on aggregating publicly available information on a physician — where they went to school, published papers, malpractice law suits, etc. Some companies, like Angie’s List, have attempted to capture patient experience. At their best these sites provide information of marginal value. Comments on care are unstructured and not attributed to a particular treatment or regimen.

Outcomes information as a measure of quality of care and meaningful patient experience remain elusive for the consumer today. We believe that there is promise in Vestar’s acquisition of Colorado based HealthGrades, the health care ratings company. Vestar also owns Press-Ganey, the hospital patient rating group. Also, new companies like DocInsight that deliver information on the patient experience show promise.

Estimating Treatment Costs?

Shopping for routine health care should be like buying groceries. NexTag, the web aggregator of prices for many technology and popular consumer items has been successful over the last decade. Castlight.com is a growing service provider that can help consumers understand the status of their health plan, i.e. how much they have to spend before meeting their deductible and provides local pricing information across providers for many routine treatments.

This step toward price transparency has far reaching ramifications and inserts supply and demand pricing pressure into local markets. Physicans pay for referrals and pay to be listed.

Naysayers will rant that it’ll never work and physicians will never sign up. Those same naysayers said the same thing about airlines and hotel groups 10 years ago. Today Travelocity, Orbitz and Expedia have a valuation in excess of the major airlines and hotel groups combined!

Getting a Fair Price

This is another area of great promise. MedicalCostAdvocate.com helps consumers negotiate better prices for treatments with payers and takes a percentage of the savings. Society wins with lower cost care which in turn will force efficiencies in providers. Patients win with lower health care expenses.

Summary

Health care is about to undergo turmoil and change like never seen before. Surfers wait for “The Wave” and the Wave is coming.  Businesses need to incubate new growth and revenue models that help the consumer be prepared.

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