This blog post is based on an interview with David Contorno, Employee Healthcare Strategist and Founder of E Powered Benefits. It has been posted with his approval and permission.
Note: AB denotes AgencyBloc and DC denotes David Contorno
Continuing with our Expert Series blogs, I had the opportunity to ask David Contorno, Employee Healthcare Strategist and Founder of E Powered Benefits, about transparent pricing within the industry, where he's projecting to see an impact, and how brokers should prepare. Thank you, David, for your time and contribution!
AB: What does transparent pricing mean?
DC: At the very least, it means getting an actual price for what is about to be done before it is done. It means getting an all in, total binding price, not an estimate. There is push back to this, but I can speak to why all of it is baloney.
AB: Where might transparent pricing be applied within healthcare?
DC: It applies to all episodes of non-emergent care. The easiest items include office visits, exams, MRIs, hernias, all orthopedic procedures, most planned cardiac procedures, and oncology treatments amongst other treatments.
AB: What are some of the proposals currently up for debate in the government and what future do you see for those proposals?
DC: The debate is over what price they should show. A single CPT code could have dozens, even hundreds, of payment levels in the current system. This is part of the problem I hope forced transparency will help correct. One hope is that this forces the system to change. What I hope doesn't occur is the dysfunction of the system is used as an excuse to not change.
AB: How does transparent pricing affect health insurance brokers?
DC: Well, that depends on the broker. If it has the pricing impact I hope it does, it will lower premiums, which will lower commission to the standard broker. For the fee-based, it will allow them to be more competitive. For those with a high degree of confidence in their ability, they can tie performance to their fees.
AB: How does transparent pricing affect health insurance carriers/companies?
DC: If it lowers underlying healthcare costs, it will also lower their premiums and therefore their profits. Transparency is not good for carriers or health systems. It is good for patients and their employers who foot the bills.
AB: What can health/benefits brokers do in their business to adjust to changes like these?
DC: Tie their fees to lowering costs and align all of the incentives.
AB: How can healthcare consumers effectively use these price lists? How can/should employers use these price lists?
DC: It is a start in determining value and building a system that is rewarded on outcomes instead of usage as it is now.
AB: Do you believe transparent pricing will lower healthcare costs?
DC: Absolutely. A robust competitive market, where both price and quality are known, always brings the price down.
AB: Do you think transparent pricing is an important factor in changing our healthcare system?
DC: Yes, I think truth and transparency are important factors in changing any market.
AB: Where do you see the healthcare system in 10 years?
DC: I see a system where providers are paid based on results, not activity. Where keeping them well results in the highest payout, not the amount of treatment they do.
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Image credit: E Powered Benefits