The first topic in our fixing healthcare series focuses on direct provider contracting: forming partnerships with care teams and patients as a direct link.
Hospitals Fought to Keep Prices Private and Lost
Not all RBP is the Same
We began working with a financial services firm in Q4 of 2019. The company had fired their PPO the year prior and transitioned to a Reference-Based Pricing (RBP) approach paying providers a percentage above Medicare allowable rates. Using RBP leverages transparency, defensibility in pricing medical services, and cuts out a lot of the waste inherent in opaque PPO pricing.
Leading the Way
Health care's runaway costs required that we re-build the benefit brokerage model from the ground up to support transformation in an entrenched industry. We’re pushing back on 50 years of hyper-inflating costs which have created immense collateral damage across society: healthcare consumes 30-40% of state budgets, #1 cause for individual bankruptcy is healthcare (72% had insurance), wage stagnation due to 20 years of cost shifting to employees, human suffering, the opioid crisis, etc.
Random Thoughts on the Passing Scene: Not all RBP is the Same
Rent Seeking PPOs
Breaking News: US Senate bill proposes Health Rosetta-style disclosure rules
A key component of the Health Rosetta strategy is transparent advisor relationships. This week, legislation was introduced by the Senate HELP committee with Chair Lamar Alexander (R-TN) and ranking Democrat Patty Murray (WA) that, among other things, will require brokers & consultants to disclose all their sources of compensation.
Lost Lives and Saved Lives
Industry Reactions: OptumRx to Pass Along Rebates
Behind the Scenes, Health Insurers Use Cash and Gifts to Sway Which Benefits Employers Choose
The Curtain has been pulled back on brokers taking financial incentives from insurers. As a Health Rosetta certified advisor, pieces like this from Marshall Allen at ProPublica (in conjunction with NPR) are critical to build a more transparent healthcare system: https://www.propublica.org/article/health-insurance-brokers-cost-commissions-bonuses.
Even the Best PBM Can't Protect Against These
Knowledge is power, especially when it comes to price variations in healthcare. Many times, the best pricing exists outside of your health plan, but how to get this information in front of employees is the biggest challenge. Even the most transparent PBM arrangements, can’t protect against uninformed decisions.
