Trump Administration Preparing Executive Order on Health-Cost Disclosure

In the healthcare industry, price transparency — knowing the price of a procedure before it’s performed — is a well-known problem that we at Medxoom have been working to help solve. This recent Executive Order from the White House requiring public price disclosure for medical service means that there may be a change coming. While we wait for government laws to take shape, Medxoom can help.  Our technology helps employers and their employees by making it very easy to do pre-visit comparison shopping for price and quality based on their plans historical claims data and public government hospital pricing data.

Why Your Health Insurer Doesn’t Care About Your Big Bills

Patients believe their insurers are fighting on their behalf for the best prices with hospitals, but saving patients money is not insurers top priority — their own profit is. A perverse incentive of the Affordable Care Act say insurers can only keep 15%-20% of premiums as profit, so higher medical bills equal higher profits.

Thus “discounted member rates” insurance companies negotiate with hospitals tend to be 3X Medicare rates for the same procedure. Even these prices, which employers and employees are legally obligated to pay, vary markedly in the same city. Medxoom technology protects employers and their employees by allowing pre-visit comparison shopping for price and quality based on their plans historical claims data.

Cat Bites The Hand That Feeds; Hospital Bills $48,512

Good Samaritan Jeannette Parker, trying to help a stray kitten, got bitten, and ended up as another recipient of “surprise ER billing.” Jeannette needed to be treated, but had no way of knowing in advance she’d be overcharged 10-fold for a rabies drug. Had Jeannette’s employer used Medxoom, she could have taken just a few minutes to look at ER stitches and rabies pricing available to her nearby. Medxoom allows patients the ability to know about how much their plan’s hospital visit will cost before visiting and allow patients to choose a hospital accordingly, lowering a patient’s out-of-pocket expenses and employer’s healthcare expenses.

TED Talk: What if all US health care costs were transparent?

Former New York Times reporter Jeanne Pinder, Founder & CEO of ClearHealthCosts.com, gave a TED Talk highlighting the wide price discrepancies charged by healthcare providers in any city and across the U.S. for the same procedure. There are no easy clear ways for patients to obtain costs for any medical procedure before getting a bill. Jeanne asks what if you could make getting and medical service like getting a laser printer with pricing and where to go information. Medxoom’s pre-service comparison shopping technology based on a plan’s historical claims data can help employees find the lower cost higher quality providers in or near their homes.

Keeping Secrets: How a Common Blood Test Can Cost $11 or Almost $1,000

Another example of big price discrepancies in healthcare costs that are unimaginable in other industries. Even for something simple like a common blood test, consumers don’t know the cost before the bill comes. With Medxoom’s Comparison Shopping technology, employees of self-insured health plans can find out the price of a blood test or other medical procedure before getting it and then go with full knowledge of the cost variances to their provider of choice in their health plan.

Insurers Hand Out Cash and Gifts To Sway Brokers Who Sell Employer Health Plans

All employers should know how their outside benefits broker is compensated. Is their income based on health insurance company commissions or only consulting fees from you? iI’s hard for PPO commissions to not influence broker recommendations to you. Make sure your financial interests are aligned.  Those who distinguish themselves as advisors or consultants rather than brokers or those who are Health Rosetta certified tend to be more transparent. Medxoom is aligned with Health Rosetta, so your costs are always transparent.

Hospitals are making a lot of money on outpatient drugs

Hospitals are making more money than ever, as evidenced by a recent study revealing the practice of marking up commonly used drugs 3 to 7 times above their average sales price. The hospital markups are causing a rise in insurance premiums, meaning a rise in healthcare costs for employees and employers. Medxoom’s price comparison technology allows patients to compare hospital prices and quality in their health plan’s network before going for procedures that include commonly used drugs.

Hospital price growth driving healthcare spending

The price of hospital care — the largest single component of healthcare costs — continues to rise. One of the main reasons is the growth and consolidation of hospitals, giving them the power to raise prices as local competition decreases. As prices continue to rise, pre-service comparison shopping for price and quality can save employer health plans 10% or more in annual hospital costs. Medxoom gives shopping power back to patients and employers with our proprietary Price Comparison technology based on an employer’s historical claims data.

Hospital Prices Outgrew Physician Prices by Almost 20%

Recent research published in Health Affairs states that “between 2007 and 2014, the growth of hospital prices outpaced that of physician prices by nearly 20%.” Despite policies meant to regulate price growth, we continue to see the rise of healthcare costs across the industry. Proposed solutions may bring relief to healthcare patients and employers in the future, but Medxoom can provide price transparency allowing for immediate savings across benefits programs now with our proprietary healthcare benefits technology.

Verma: CMS intends to disrupt healthcare by empowering patients

CMS Administrator, Seema Verma, believes the current lack of information available for patients leaves them unable to make informed decisions about their own health. Legislation was proposed in multiple keynote sessions at HIMSS19 to help address this issue. While the government works on passing legislation, Medxoom can provide price transparency for employer plans right now, enabling data-driven actions to lower and manage healthcare costs.