Latest / Becker’s Payer Issues Podcast / The Future of Price Transparency: Insights from Sidecar Health’s Emily Porter

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The Future of Price Transparency: Insights from Sidecar Health’s Emily Porter · Becker’s Payer Issues Podcast

0:00
Hello, everyone. This is Jacob Emerson with the
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Becker's Payer Issues podcast.
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Thrilled today to be joined by Emily Porter,
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who is the vice president of external affairs
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at Sidecar Health. Emily, thank you so much
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for taking the time to be with me
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on the podcast today.
0:14
Sure. Thank you for having me.
0:16
So before we dive into everything we wanna
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talk with you about, Emily, and, a big
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policy change going on in Washington, can you
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talk to us a little bit about your
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career background and what it is that you're
0:25
doing today at Sidecar Health?
0:28
Sure. So I,
0:30
I got my my career start at a
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think tank in Washington DC.
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I won't say how many decades ago, but
0:37
many years ago.
0:39
And then I worked on Capitol Hill for
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about a decade. So I spent most
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of that decade working for,
0:47
former congressman John Boehner
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and worked for him in the majority leader's
0:51
office and in his his role in the
0:53
leadership generally
0:55
as minority leader, and then I I ended
0:58
my role with him in the speaker's office.
0:59
So I left The Hill, about twelve years
1:02
ago, and then I went to work at
1:04
a small boutique lobbying
1:06
firm in Downtown
1:07
DC where many of our clients were all
1:10
in the health care sector, so anything from
1:12
insurance to hospitals to medical device.
1:15
And then one of those clients that we
1:17
had was, Sidecar Health.
1:19
And I was very intrigued at the outset
1:22
about what Sitecore Health has to offer. It
1:24
was truly the only thing I had seen
1:27
in my career that
1:29
actually creates
1:31
a market incentive for consumers to be engaged
1:34
in probably the most meaningful way,
1:36
that they've ever been engaged in health care.
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And
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that was that was really exciting for me,
1:41
having been on Capitol Hill during
1:44
the Medicare part d program consideration,
1:47
during the
1:48
Affordable Care Act consideration and multiple other pieces
1:51
of of big legislation that I'm sure we're
1:53
all familiar with. But this was really something
1:55
that
1:56
I thought was the most interesting in terms
1:58
of not requiring
2:00
any sort of government
2:01
subsidy or tax credit or some of the
2:03
more,
2:04
some of the more obvious
2:06
carrots and sticks that we see in other
2:08
legislation.
2:10
Fantastic. So you've got a long career in
2:12
in politics and in DC, Emily, and that's
2:14
why we wanted to come to you to
2:16
ask specifically about
2:17
president Trump signing a new executive order in
2:21
February aimed at cracking down on price transparency
2:24
requirements for hospitals and insurers. And that, of
2:27
course, follows his original executive order on health
2:30
care price transparency back in 2019.
2:33
So I think the natural question there is,
2:35
what is the difference? What changes
2:38
do insurers need to know about this new
2:41
EO?
2:42
What's what does it do differently?
2:44
So as you as you articulated, Jacob, in
2:47
the previous executive order, health plans and hospitals
2:50
obviously were both swept up in that, but
2:51
health plans were instructed to
2:54
post their negotiated rates with providers and their
2:57
out of network
2:58
payments to providers and then the actual prices
3:00
that they paid for prescription drugs.
3:03
And then they had to maintain an online
3:05
tool in order to permit
3:08
customers to access that particular pricing information.
3:12
This executive order,
3:14
which we're very supportive of, obviously, at Sidecar
3:17
Health because we we are a major medical
3:19
product based on price transparency
3:21
and giving consumer information. But this executive order
3:24
requires
3:25
the,
3:26
requires the plans and hospitals
3:28
to put up actual pricing. So
3:31
previously, I think we've seen a lot of
3:33
estimates.
3:33
And so now there is a requirement that
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actual prices
3:38
must be disclosed,
3:40
and it requires that the department determine what
3:43
kinds of enforcement policies
3:45
they want to implement
3:46
to ensure that the providers are compliant.
3:50
So it will mean that not only will
3:52
health care entities have to determine how they
3:54
disclose a price in
3:56
Toledo, Ohio
3:57
or
3:58
Jacksonville, Florida, but but that becomes, I think,
4:01
a very meaningful and and different way that
4:03
for the consumer
4:05
and the plans to figure out how to
4:07
share that pricing so that it's constructive and
4:09
and useful.
4:11
Absolutely. So more concrete information,
4:14
actual prices, not estimates being required from insurers
4:17
across the country.
4:19
And so you mentioned insurers have been required
4:21
to disclose a lot of this pricing information
4:24
starting in 2022.
4:26
It staggered from there over the years.
4:28
So what's compliance been like, from your perspective,
4:31
Emily, up until now across the industry?
4:34
Are are insurers actually following these rules?
4:38
So first, I'll say that, just
4:41
go on with your question here in a
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second. But first, I I will say I
4:44
do think
4:45
that insurers are supportive of transparency. I think
4:48
the crux of the issue has always been
4:51
applicability
4:53
and making sure that it's applicable in a
4:56
uniform way and having the kind of data
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that
4:59
that is displayed in a consistent
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consumer friendly format. I think that's where it
5:04
can be a real game changer for the
5:05
consumer, and we see this every day in
5:08
what we do at Sycor Health. I think
5:11
I think under these particular
5:14
executive orders so first of all, the hospitals
5:16
were required to disclose that information prior to
5:19
insurers
5:20
being required to in 2022.
5:22
So I think you've seen some some delay,
5:25
in enforcement
5:27
really because I think in part, it was
5:28
tied up in courts for a while.
5:30
And but I think we all share the
5:32
goals, obviously, of giving consumers the information to
5:35
make good choices, but there has been a
5:38
bit of a lag in the Biden administration.
5:40
But I think there's always going to be
5:42
different priorities
5:44
depending on who is in the White House
5:46
and what the directives
5:48
are from the senior folks at those
5:50
departments. And I think
5:52
in this particular instance,
5:55
you know, there's maybe not been
5:59
some of the processing of pricing data
6:02
that has been a priority
6:04
when you think about
6:06
all of the other issues that both hospitals
6:10
and insurers are trying
6:12
to work on every single day that really
6:14
has nothing to do with price transparency, but
6:17
is trying to is trying to work on
6:19
just other issues related to Medicare or Medicaid
6:22
and and different payments. So but I I
6:24
do think,
6:25
overall,
6:27
hospitals and insurers, like, we very much value
6:29
our hospital partners. And when it comes to
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giving consumers
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pricing information,
6:34
we share those goals,
6:36
but we really just wanna make the experience
6:38
for the consumer smooth. And I think that's
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where
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sharing actual data
6:43
is really gonna be a game changer in
6:45
terms of, let's call this,
6:48
executive order two point o, in terms of
6:50
how this second executive order really sort of
6:53
forces
6:54
that positive direction, I think, forward for the
6:56
next generation of of pricing in health care.
7:00
Absolutely. Absolutely. And you mentioned some of the
7:02
challenges and delays we've seen in enforcement. And
7:05
and just so our audience is aware for
7:06
context, we know that 18 hospitals have been
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fined for for noncompliance with these rules since
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they first came out. No insurers have been
7:14
by CMS. So so that's where things currently
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stand.
7:17
But but, Emily, you mentioned that this all
7:19
comes back down to making things easier in
7:21
health care for the consumer. So
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where do things stand in terms of, third
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party companies and consumers' ability
7:29
to to use this data, and to know
7:31
what their health care costs will be before
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they they go to the doctor's office?
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Sure. So I think it's always good for
7:39
consumers and or for hospitals and insurers to
7:42
provide this data, as you say, in a
7:43
more actionable way. I think that helps move
7:46
the ball forward and creates a more educated
7:49
health care population. And this really is
7:52
the next generation of evaluating what those next
7:54
steps are. And in any sort of
7:56
public policy,
7:59
any sort of public policy development, there's always
8:01
going to be room for progress.
8:04
And I think this exercise
8:06
from the Trump administration
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is
8:09
a smart exercise in terms of
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how to make that public policy more effective
8:15
for the consumer. I think we wanna make
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sure providers obviously,
8:20
are providing that information
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in a way that is digestible. Consumers are
8:25
savvy, and that's something that I've learned a
8:28
lot about at SacroHealth, but they like having
8:30
additional information to the extent that they're able
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and being able to share that information in
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a way that is
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is digestible.
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And like I said earlier, in a uniform
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manner,
8:42
in a way that they're buying anything else
8:44
throughout their daily lives, that's a real that's
8:47
a real,
8:49
step forward. And we wanna make sure, obviously,
8:51
providers
8:52
that they don't need to go through prior
8:54
authorization and they don't have to pay,
8:57
or that we don't have to pay with
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a middleman. There should be immediate payment, and
9:01
there is a privilege for the customer to
9:02
be able to choose what they want. And
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sharing
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pricing
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is part of the process or a step
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in giving them that privilege to be able
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to go wherever they wanna go. I do
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think sharing this kind of data also opens
9:16
the door for other innovation
9:19
in the healthcare sector, which we think innovation
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is is always a good thing.
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And it will probably result in more opportunities
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for,
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you know, think about the the Google Healths
9:30
and the Amazons of the world to create
9:32
other innovative models that help give consumers the
9:36
tools they need to be
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smarter and better consumers. And whether it's through
9:42
artificial intelligence
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or
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website
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tools or just other,
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more intuitive ways to get information,
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I think that that that is always gonna
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be a positive step forward.
9:55
Absolutely. Yeah. It is very exciting to think
9:57
about what could come from this new executive
10:00
order within the private sector. Yeah. But, Emily,
10:03
before we go, I think would you educate
10:04
our audience on on the Sidecar Health model
10:07
and how you all are using the price
10:09
transparency
10:10
data today?
10:12
Sure thing. So Sidecar Health is a large
10:14
group major medical insurance product.
10:18
We give consumers
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pricing information so that they know what every
10:22
single thing in the health care system
10:24
can cost, and we give them that data
10:27
on our website. And so they're able to
10:29
compare,
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and we do this for all 170,000
10:32
things you can do in the healthcare system,
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as well as for any FDA approved drug.
10:37
So the consumers can compare
10:40
and determine where they want to go because
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we don't have a lot of the more
10:45
onerous
10:45
or frustrating things that that more traditional insurers
10:49
have. We don't have a network. We don't
10:51
have prior authorization.
10:53
We don't have set therapy or formularies. And
10:55
again, we just don't have some of the
10:57
more burdensome
10:58
things. So we give the cons we give
11:00
the consumer,
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a budget that they need to be able
11:03
to shop, and then it's up to them.
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If they wanna go someplace that is over
11:07
the budget that we're giving them, that's totally
11:10
fine. That's their prerogative. But if they want
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to go someplace that that costs less, we're
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gonna let them keep part of that savings.
11:18
And so it really is a game changer
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when you think about the consumer having more
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skin in the game
11:23
and and being able to consume health care,
11:25
like I said earlier, in a meaningful way,
11:27
in a way they consume everything else in
11:29
their lives. But we're really excited about what
11:31
we've seen from consumers so far. Like I
11:33
said, consumers are really smart and they like
11:36
having the data. And we're seeing about 90%
11:38
of our claims come back where consumers
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are getting their services either at the budget
11:44
that we give them or slightly above with
11:47
maybe what we consider like a co pay
11:50
amount, like $15 or $20
11:52
but they're choosing also to go to sites
11:53
of care that are less costly and
11:56
are finding a lot of success also at
11:58
the pharmacy and saving a lot of money
12:00
and being able
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to, you know, kind of almost compete a
12:05
little bit sometimes with their coworkers. I know
12:06
we certainly do that inside the company in
12:08
terms of where we found good prices. And
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it really is an eye opening and exciting
12:13
experience for both just us, but also the
12:16
consumer. And we love hearing love hearing all
12:18
the feedback.
12:19
Well, appreciate that overview, Emily, and it'll be
12:21
fascinating to watch as a sidecar continues to
12:24
disrupt across the industry.
12:26
Before we go, we've got a lot of
12:28
health plan leaders listening in. Any final thoughts
12:31
or final bits of advice you wanna offer
12:34
them in terms of, this this new executive
12:36
order and what that means for price transparency
12:39
moving forward?
12:40
Well, I think there's I do think sometimes
12:43
there's an impression that perhaps
12:46
there's, I think, a lot of opposition
12:48
to price transparency depending on what industry. And
12:51
and I think I'd like to maybe just
12:53
share. I don't think that's true. I think
12:55
there is a lot of support for transparency.
12:58
I think that
12:59
there is a lot of
13:01
there are a lot of federal and state
13:03
programs that both hospitals and insurers are trying
13:05
to comply with. And so there's a little
13:07
bit of a a push pull between
13:10
between where some of the attention can be
13:12
focused. But I do think that
13:14
insurers and, like I said earlier, our hospital
13:17
partners,
13:18
they're supportive of giving the consumers
13:20
more information
13:21
and more,
13:23
more information that'll make them better consumers because
13:27
we want the consumer to have a smooth
13:29
experience. And so I think we do all
13:31
truly have,
13:32
you know, shared goals in that area. This
13:34
probably I'm maybe giving you more of a
13:37
a kumbaya answer than you wanted, but but
13:39
I do think sometimes in the field, there's
13:41
a little bit of a, the sense that
13:43
there's consternation. And I think in this case,
13:46
there isn't. I think because the prices have
13:48
been somewhat hidden for quite some time that
13:51
it's
13:52
a different administrative role to make some of
13:55
that pricing more public, but we're really excited
13:57
to have allies in that effort. And we're
13:59
very grateful
14:01
to have all the providers that that we
14:03
have that that do take Sitecore Health customers
14:05
because we wanna make that experience really
14:07
enlightening and smooth for the consumer.
14:11
Fantastic. Well, Emily, thank you so much for
14:13
taking the time to sit down with us
14:14
and for sharing your insights with our listeners.
14:16
We really appreciate it. Thank you so much.
14:19
And if you'd like to listen to more
14:21
podcasts from Becker's Healthcare, you can visit beckershospitalreview.com.