9/4/2018

ClearHealthCosts: Making healthcare prices more transparent

 

By Jeanne Pinder, founder and CEO, ClearHealthCosts

The U.S. healthcare system hides prices from people. ClearHealthCosts is here to change that.

In our system, quite often a bill for medical treatment or service is submitted by the provider first to an insurer (government or private insurance) and then only later is any information about cost delivered to the person who had the procedure. In fact, it's possible for a person who is prescribed a simple procedure like an X-ray or an MRI scan to get the procedure, leave without knowing the cost, and receive a whopping bill months later. 

On top of that, prices vary widely, even by a factor of 20 or more. For example, a common MRI could cost you $300 at one place locally, or $6,000 at another. A common blood test could be $19 one place and $522 at another. Your insurance might cover all, part or none of the cost.

This seems bizarre to people from other nations with more straightforward systems. In fact, many non-U.S. citizens cannot fathom how someone can be asked to pay ruinous sums of money for a basic thing like healthcare. This system is often driven by for-profit companies seeking to maximize their income, which is one reason why this secrecy over prices has persisted. Of course, any kind of information asymmetry means someone is making money.

How do we do our work?

We're a journalism startup from New York bringing transparency to the healthcare marketplace by telling people what stuff costs at ClearHealthCosts.com.

Using shoe-leather journalism, data journalism, investigative reporting and crowdsourcing, we reveal the secrets of healthcare pricing both on our home site and in partnership with other news organizations, diving deep into local healthcare pricing. 

In addition to revealing price disparities, we tell people how to navigate in the healthcare system. Not infrequently, you can save money by putting away your insurance card and paying cash. This kind of "news you can use" is valuable to people trying to understand the system.

In our New Orleans partnership, for example, we have set the town on fire with partners NOLA.com I The Times-Picayune and WVUE Fox 8 Live, the city's two biggest newsrooms. Here are some of the outcomes:

  • Hundreds and hundreds of people shared prices, stories and very personal details about healthcare. Thousands and thousands searched prices.
  • We saved one woman $3,786. Others saved hundreds and hundreds.  
  • We were instrumental in passing consumer protection legislation. (Impact!) 
  • Hospital CEO's yelled about us; legislators and regulators praised us. 
  • Deep Throats whispered in our ears.
  • Our stories and Facebook Lives have thousands and thousands of views and shares. 
  • We heard from fraudbusting lawyers.
  • Our partners win journalism prizes.

People stopped our reporters on the street to tell how much they appreciate what we're doing. It is a wave of approval expressed in face-to-face interactions, Facebook comments, comments on our stories, phone calls and emails. This is the kind of job satisfaction few people get to experience on such a sustained and emotionally charged level.

It's not just uninsured people, but also insured people fighting high deductibles, co-insurance, out-of-network spending and gotcha bills.

We also heard from people who said things like "some friends asked me to send you these [insurance statements] -- they don't have internet access."

Getting the data

How we do it: we survey providers by phone in our target metro area to collect their cash prices on a range of common, "shoppable" procedures. In calling these providers, we get a range of prices that’s useful for our community members to measure what they’re being charged, or to “shop” for a procedure. We prepopulate our partners' databases with this information. 

Our interactive software, on their sites, displays this data, and also shows the Medicare rate for that procedure in that location. The rate paid by Medicare, the U.S. government program covering the elderly and disabled, is the closest thing to a fixed or benchmark price in the marketplace. It’s governed by a mind-numbing formula and an underlying set of government files referring to some 8,400 procedures categorized by procedure codes, and broken down by some 90 locations (a doctor in Manhattan is paid more than a doctor in rural Idaho). Details on this system can be examined here.

Then we invite community members to contribute their experiences and their prices. In doing so, we create a 360-degree view of pricing -- not a perfect data set, but one that reveals tons.

Lessons in crowdsourcing

The design thinking that went into building our crowdsourcing software includes some basic assumptions.

First, we made all the shared data publicly visible by default, rather than insisting on pre-moderating. Our communities know more than we do about a lot of things, and we join hands with them in this act of co-creation. Also, in the spirit of crowdsourcing, we trust our communities to tell us plainly what they know -- and we don't believe there are a lot of people out there who want to lie to us about their mammogram costs.

Other lessons:

  • Listening to our community is key.
  • Making a clear ask is important.
  • Making it easy for people to reach us is paramount -- they can reach us by sending us things on the widget, emailing us, calling us, stopping us on the street, buttonholing us at a party.
  • Responding as quickly as possible to our community members has been a top priority. If they send us a price via the widget, or email us or leave us a voicemail, we respond. 
  • Thanking people for helping is polite.
  • This is a very emotionally laded issue for many people -- they've called us "extraordinary" and "awesome" and "genius" for tackling this topic. We're sensitive to what they're going through.

One other big takeaway: we have done a ton of work by collecting prices before asking people to help us by reporting their experiences. That has made a huge difference. They know we're asking them to help us solve this problem, and they're emotionally invested in it -- because they've experienced these problems themselves, and wish to join hands with us to help others. 

Also, if people don't want to share their prices, they can still interact with us by searching (or commenting on Facebook, or any other means of interacting).

The internet hates lying and secrecy. This constant effort by various players in healthcare to keep prices secret must end, and we're here to make that happen as soon as possible.

Dialogue and engagement

We have generated hundreds of conversations about health costs that don’t just point at the problem -- rather, we have given people a voice in the debate, and agency in controlling health spending. 

It's what our news partners called "the Holy Grail of engagement”, which is what news organizations are seeking these days. 

Using the tools of journalism, we also encourage and enable dialogue by telling CEO's what patients think, letting independent doctors contribute their expertise, showing lawmakers and regulators what's really going on among patients. All the stakeholders can read and watch our journalism, and email or call or share their knowledge.

Below a 3-minute sizzle reel of our TV work; here's an hour-long TV special. Here's an entire project page cataloging work by us and about us (Niemanlab at Harvard!). 

Our partnerships

We've done partnerships with about a dozen news organizations nationwide. We’re always interested in partnering with other journalists on this topic.

We just launched in Philadelphia with The Inquirer, The Daily News and Philly.com, and 6ABC Action News, after winning part of a Lenfest Institute grant.

Other partners: KQED public radio in San Francisco (on hiatus); KPCC public radio in Los Angeles (on hiatus); WLRN public radio in Miami; WUSF public radio in Tampa-St. Pete, and others. Our news partnership pilot in 2013 was with WNYC public radio in New York.

"Cracking the Code" won a 2017 Suncoast Regional Emmy for WVUE Fox 8 Live. NOLA.com I The Times-Picayune is a finalist for a regional AP competition.

Our Philadelphia partner, Elana Gordon at WHYY public radio, won the Public Service gold medal for work done via our PriceCheck partnership at the Pennsylvania AP Broadcasters Association awards banquet.

In 2015, Lisa Aliferis and Lisa Pickoff-White of KQED public radio won the Journalism Innovation Award for the Society of Professional Journalists Northern California awards.

We were a finalist in the 2015 Online Journalism awards for Explanatory Reporting (Medium) but did not win. 

Our California prototype was funded by a Knight Foundation grant, reported here on The John S. and James L. Knight Foundation blog.

About the author

Jeanne Pinder is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as an editor, reporter and H.R. exec before volunteering for a buyout in 2009. A year later, she won a shark-tank-type pitch contest in front of a jury of New York City venture capitalists and internet illuminati who awarded her $20,000 to build a business with journalism DNA telling people what stuff costs in healthcare. Before The Times, she worked at The Des Moines (Iowa) Register, The Associated Press and The Grinnell (Iowa) Herald-Register, a twice-weekly newspaper her grandfather bought in 1944, which is still proudly independent under the leadership of her two sisters. Reach her at .(JavaScript must be enabled to view this email address).

Explore the project here.

 

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