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Revealing How Much Health Care Really Costs · What's Your Problem?

0:15
Speaker 1: Pushkin. Imagine you're going to buy a car. You go
0:22
Speaker 1: to the lot, you test drive the car, You tell
0:25
Speaker 1: the sales guy I like it, I want to buy it.
0:28
Speaker 1: And the sales guy says, go ahead, drive away. Car
0:31
Speaker 1: is yours and you say, okay, great, But how much
0:35
Speaker 1: is this car going to cost? And the sales guy goes,
0:38
Speaker 1: I don't know. I can't tell you. Maybe it's twenty
0:41
Speaker 1: thousand dollars, maybe it's thirty thousand dollars, maybe it's forty.
0:46
Speaker 1: We'll send you a bill in like a month when
0:47
Speaker 1: we figure it out. This is obviously absurd. It's not
0:51
Speaker 1: the way buying a car works, but it is a
0:54
Speaker 1: lot like the way it works when you go to
0:56
Speaker 1: the hospital for say, surgery. Nobody can tell you in
0:59
Speaker 1: advance exactly how much it's going to cost, and then
1:03
Speaker 1: a month later, when you don't have any painkillers left
1:05
Speaker 1: to blunt the impact, you get the bill. Surprise. I'm
1:13
Speaker 1: Jacob Goldstein, and this is what's your problem. My guest
1:16
Speaker 1: today is Chris Severn, the co founder and CEO of
1:19
Speaker 1: Turquoise Health. Chris's problem is this, how do you make
1:23
Speaker 1: healthcare prices transparent, not just for consumers, but for hospitals, insurers, businesses,
1:30
Speaker 1: for everybody. People have been trying to solve this problem
1:33
Speaker 1: for decades, but there's a good reason to think that
1:36
Speaker 1: this time really is different. In twenty nineteen, the federal
1:40
Speaker 1: government issued a new rule. This rule said insurers and
1:45
Speaker 1: hospitals are going to have to publish their prices, not
1:48
Speaker 1: just the fake list prices that nobody pays, but the actual,
1:52
Speaker 1: real negotiated prices. This rule is just starting to take effect,
1:57
Speaker 1: and Chris says it's impact in the long run could
2:00
Speaker 1: be huge. So it's a pretty simple story. You know,
2:06
Speaker 1: before twenty nineteen, the true price of healthcare was unknown
2:12
Speaker 1: to anybody who wasn't privy to these contracts negotiated between
2:16
Speaker 1: insurance companies and hospitals. And this is a this is
2:19
Speaker 1: an insane fact. Oh insane. I mean, it's obviously true.
2:23
Speaker 1: If you're a patient and you're going to go and
2:25
Speaker 1: they can't tell you, is it going to cost a
2:26
Speaker 1: thousand dollars? It could cost five thousand, they can't tell you.
2:29
Speaker 1: But like one hospital didn't know what another hospital was charging,
2:33
Speaker 1: different insurers getting wildly different rates, like just a weird, weird,
2:37
Speaker 1: huge money world, exactly, And it is crazy. And that's
2:41
Speaker 1: the world that sort of I professionally grew up in
2:45
Speaker 1: for ten years and we were just used to it.
2:47
Speaker 1: You know, these secret PDF contracts that were protected as
2:50
Speaker 1: trade secrets could not be disclosed. There were these things
2:52
Speaker 1: called gag clauses. When you say you grew up and
2:54
Speaker 1: you were a consultant for hospital billing, basically, right, exactly exactly,
2:59
Speaker 1: And you know, there's an interesting nugget in ACA that
3:02
Speaker 1: required hospitals to disclose their standard charges was the word okay,
3:08
Speaker 1: And it was basically the Obamacare law that was passed
3:11
Speaker 1: more than ten years ago, now right, yep. And nothing
3:14
Speaker 1: really happened with that for a while, and then legislators
3:17
Speaker 1: started turning attention and rulemakers started turning attention to it, saying, hey,
3:21
Speaker 1: we really need to get the prices of healthcare out there.
3:24
Speaker 1: We're going to and this came through the Trump executive
3:26
Speaker 1: orders in twenty nineteen. There were a few of them.
3:29
Speaker 1: Hospitals must disclose their standard charges for the price of healthcare,
3:34
Speaker 1: and insurance companies must disclose their standard charges. So you've
3:37
Speaker 1: been working in basically hospital billing, right, hospital revenue, you
3:42
Speaker 1: see this rule come, Like, when do you decide to
3:46
Speaker 1: start the company and like, how does it fit with
3:48
Speaker 1: this story? Yeah, so the rule was proposed, so the
3:53
Speaker 1: executive order. I remember where I was with my co
3:55
Speaker 1: founder Adam because we were running a business together separately
3:59
Speaker 1: or separate from Turquoise, and we saw the rule come out.
4:02
Speaker 1: We were like, are you are you reading this same way?
4:04
Speaker 1: I am. We're like, I think this means all these
4:07
Speaker 1: contracts we see are going to become If it is
4:10
Speaker 1: what you think it is, it's going to be a
4:11
Speaker 1: big deal. Right, Oh yeah, totally. This is going to
4:14
Speaker 1: totally flip the economics of healthcare on its head. It
4:17
Speaker 1: could create true consumerism and healthcare. It could create true
4:22
Speaker 1: macroeconomic pressures in healthcare, and I want to be a
4:25
Speaker 1: part of it. Essentially. So it's this moment when when healthcare,
4:28
Speaker 1: when this giant part of the economy that has been opaque,
4:32
Speaker 1: is going to get less opaque, It's going to get
4:34
Speaker 1: more transparent. You think maybe patients will finally be able
4:38
Speaker 1: to actually figure out what healthcare is going to cost,
4:40
Speaker 1: maybe they'll be able to shop around. And you decide
4:43
Speaker 1: to start this company, Turquoise Health, to kind of get
4:46
Speaker 1: in on this moment. What exactly are you setting out
4:49
Speaker 1: to do. So we decided late twenty twenty that we
4:54
Speaker 1: were going to build the price transparency page of every hospital.
4:58
Speaker 1: You know, a hospital's website's not very good, they're going
5:00
Speaker 1: to hide this information. So at the time, I went
5:05
Speaker 1: on a New Year's vacation with my girlfriend at the
5:11
Speaker 1: time now my wife, and I was on my computer
5:14
Speaker 1: New Year's Eve checking hospital websites with Adam, my co founder,
5:18
Speaker 1: and we were basically waiting for these files to come live,
5:21
Speaker 1: these pricing files to come live. And I remember laying
5:24
Speaker 1: out by the pool with my laptop and just like
5:26
Speaker 1: refreshing common health system pages because these files ended up
5:31
Speaker 1: being so hidden, just like we predicted on every hospital's website.
5:35
Speaker 1: So to go find them to make sense of them
5:37
Speaker 1: became really our whole challenge of last year a twenty
5:40
Speaker 1: twenty one. And then this year there was another step
5:44
Speaker 1: right where insurers also had to post what they pay
5:48
Speaker 1: for each procedure freach hospital. Yes, that was just the summer, right, Yeah,
5:53
Speaker 1: this is step two and that is just another huge
5:57
Speaker 1: watershed moment. So can we go online right now and
6:02
Speaker 1: like actually look at something that will sort of help
6:06
Speaker 1: me understand kind of how this works and why it's meaningful. Yeah,
6:09
Speaker 1: So how would you like me to do it? Would
6:11
Speaker 1: you want to pull up a page or um? So? Okay?
6:13
Speaker 1: So I have turquoise dot health uh and it says
6:17
Speaker 1: enter service name or code and has a zip code. UM,
6:21
Speaker 1: So exactly what's a what's a what's a good basic service?
6:25
Speaker 1: That's gonna just tell me what to enter? Just talk
6:28
Speaker 1: me through it? Yeah. I usually type in colonoscopy. Okay,
6:33
Speaker 1: there's a lot of different uh sub subsets that that
6:37
Speaker 1: auto populate. Is there one particular version of it I
6:41
Speaker 1: should type in? Yeah? Maybe some diagnostic colonoscopy is is
6:44
Speaker 1: pretty common, okay, colonoscope Comma diagnostic yep um. And the
6:50
Speaker 1: zip code here in New York. Okay, So I got
6:53
Speaker 1: one hundred and twenty six results yep um, and it
6:58
Speaker 1: looks like what it's showing me first is the is
7:01
Speaker 1: the cash price? So there's Memorial Sloan Kettering, very well
7:05
Speaker 1: known hospital four thousand, one hundred and thirty six dollars,
7:08
Speaker 1: So seems like a lot. But then I scrolled down
7:12
Speaker 1: and I see New York Presbyterian, while Cornell Medical Center
7:15
Speaker 1: also fine institution eleven thousand, seven hundred dollars. So the
7:19
Speaker 1: difference between four thousand and eleven seven hundred for the
7:23
Speaker 1: same procedure is huge. We kind of know this, right,
7:25
Speaker 1: it's absurd. We also know that the cash price is
7:28
Speaker 1: not that meaningful, right, it's sort of arbitrary. It's weird.
7:31
Speaker 1: Most people don't pay it. So it also says, see
7:34
Speaker 1: all rates? Should I click? That? Is that where the
7:36
Speaker 1: action is? Yeah, and when you see y'all rates, you'll
7:39
Speaker 1: see a drop down of whatever insurance plans they disclosed
7:44
Speaker 1: to let me do. Oh, one of them doesn't take
7:48
Speaker 1: my insurance, which is kind of surprising to meet. This
7:53
Speaker 1: can't be right, There's no way. There's no way. Sloan
7:58
Speaker 1: Kettering doesn't take Signet and doesn't take Blue Cross. Right,
8:00
Speaker 1: there's no way. And so the open secret in healthcare
8:04
Speaker 1: in our industry is that even though the rule required
8:10
Speaker 1: hospitals to disclose their negotiated rates, their prices for healthcare,
8:14
Speaker 1: pricing often is not that simple. It's not a flat
8:19
Speaker 1: dollar amount, and so sometimes the way that a rate
8:22
Speaker 1: is calculated is using a formula or convoluted math, so
8:26
Speaker 1: they omit it. So is this not that useful yet?
8:30
Speaker 1: Is that what I should take away from this that
8:32
Speaker 1: like this really common procedure at this really big hospital,
8:35
Speaker 1: they don't have the information for like really big insurance companies.
8:38
Speaker 1: That seems like a problem. And now what we have
8:41
Speaker 1: is a bit of Swiss cheese. You know, you sometimes
8:45
Speaker 1: find the rate and sometimes you're left scratching your head
8:48
Speaker 1: with cheese with maybe more whole than cheese. At this point,
8:51
Speaker 1: still we don't have all the information we need yet,
8:54
Speaker 1: like is it coming yep, So we're at a snapshot
8:58
Speaker 1: in time where this is still you know, we're in
8:59
Speaker 1: the first inning and as of July first, we mentioned
9:04
Speaker 1: that pair rule that came out. That pair rule remedies
9:08
Speaker 1: the issue that you're looking at, and that means that
9:10
Speaker 1: companies like Turquoise can fill in the gaps of what
9:13
Speaker 1: you just mentioned. So we probably now have in our
9:15
Speaker 1: data the signa rate from Memorial slum kettering, and you're
9:19
Speaker 1: going to add that if I come back in what
9:21
Speaker 1: a month, six months, when's it couldn't be there? Yeah,
9:24
Speaker 1: this is pretty new. So we're forty nine days in
9:26
Speaker 1: and we're gonna be rolling out services at a time,
9:28
Speaker 1: so you know, realistically one to two months for now
9:31
Speaker 1: for common services like that you would see this really soon. Yeah,
9:35
Speaker 1: so there's there's a lot of optimism. So so okay,
9:39
Speaker 1: the data is some of the data is there now
9:41
Speaker 1: but kind of not enough, right you, kind of there's
9:44
Speaker 1: some critical mass and like we're almost there. There's going
9:46
Speaker 1: to be a lot more information available about pricing in
9:49
Speaker 1: a really granular way soon. Yes. So then the big
9:52
Speaker 1: question is like what's it gonna mean? Who's going to
9:55
Speaker 1: do one with it? We have a couple of different products.
9:59
Speaker 1: One is a data product that's basically like get an
10:02
Speaker 1: idea of the rates an XYZ region and so who
10:06
Speaker 1: would use this? Um and new surgery center may use
10:11
Speaker 1: is to figure out where to set up shop. So
10:14
Speaker 1: you have money, you're an investor, you want to start
10:18
Speaker 1: surgery centers, and you see that this particular kind of
10:20
Speaker 1: surgery that you are set up to do is like
10:23
Speaker 1: really expensive at a certain place, you might go open
10:26
Speaker 1: your surgery center there and offer it at a lower price. Yeah,
10:29
Speaker 1: Like it's so silly. I'm a nerve, but I get
10:31
Speaker 1: goose bumps thinking about that, because it's like, if you
10:34
Speaker 1: see that there is a health system that is you
10:37
Speaker 1: got the whole northeast portion of a state, just unlock
10:41
Speaker 1: and their prices are really high. And now you might
10:43
Speaker 1: see a savvy entrepreneur say, hey, I'm going to PLoP
10:46
Speaker 1: a bunch of orthopedic surgeons out in Northeast forever, and
10:50
Speaker 1: we're gonna start undercutting this health system because we know
10:53
Speaker 1: how much it costs to do this procedure. So that's one.
10:56
Speaker 1: What are some other kind of lines of business for you?
10:58
Speaker 1: What other kinds of people or institutions are paying you? Yeah,
11:02
Speaker 1: So one example is we have several startup insurance companies
11:06
Speaker 1: paying us. And these startup insurance companies say, hey, wow,
11:10
Speaker 1: some of those other insurance companies in my market don't
11:14
Speaker 1: seem to be operating efficiently in negotiating appropriate prices for
11:18
Speaker 1: this population. And we think we can create a leaner
11:23
Speaker 1: health insurance platform so that we could charge you know,
11:27
Speaker 1: our patients pay less and they have a better member experience.
11:30
Speaker 1: And so that's I'd say, that's in the same vein
11:33
Speaker 1: as like a large employer will come to us and say, hey,
11:36
Speaker 1: we've been working with this carrier for a long time,
11:39
Speaker 1: and we just want insurance company with this insurance company, yeah,
11:43
Speaker 1: and we just want to see if there are other
11:44
Speaker 1: options out there and if we're getting a fair deal.
11:47
Speaker 1: And that's a very common conversation we have. Are like
11:51
Speaker 1: big hospitals coming to you also are big insurance companies.
11:54
Speaker 1: I mean, so far you've talked about the kind of
11:56
Speaker 1: STARTUPPI you know, disruptor types. What about the kind of
12:01
Speaker 1: big incumbents are they? Are they your clients? Yeah, there's
12:04
Speaker 1: a lot of the big I mean, the big incumbents
12:06
Speaker 1: are They're concerned, they're concerned, they're over priced, They're concerned
12:11
Speaker 1: that they are not doing all they can to get patients,
12:16
Speaker 1: and so they are coming to us. And part of
12:19
Speaker 1: the thing with hospitals is they're not just competing with
12:22
Speaker 1: other hospitals, right, They're also competing with places like outpatient
12:27
Speaker 1: surgery centers, and it seems like there's huge potential for
12:30
Speaker 1: price competition there. Yeah, So we talked earlier about a
12:34
Speaker 1: NIE meniscus repair. If you get that NI meniscus repaired
12:37
Speaker 1: done in a hospital outpatient department, you have a different
12:43
Speaker 1: cost structure because that hospital has to run, lights have
12:46
Speaker 1: to stay on, they have a bunch of employees. And meanwhile,
12:50
Speaker 1: you know, five miles down the road there may be
12:53
Speaker 1: a surgery center with a very comparable surgeon, and the
12:56
Speaker 1: cost structure is just simpler. You know, they've got the nathesiologists,
13:01
Speaker 1: they've got a smaller building, they've got fewer nurses, simpler
13:04
Speaker 1: billing practices, simpler contracts. A lot of these surgery center
13:08
Speaker 1: contracts are just almost like a restaurant menu. Can you
13:11
Speaker 1: give me just a sense? I mean I could, I
13:12
Speaker 1: could go look it up, or we could look it up.
13:14
Speaker 1: But do you know since I mean, if meniscus repair
13:17
Speaker 1: is when you look at a lot, yeah, more or less,
13:20
Speaker 1: what might the price be at the hospital versus at
13:23
Speaker 1: a at a surgery center. Yeah, very common to see
13:27
Speaker 1: common knee procedures and shoulder procedures, all those kind of
13:30
Speaker 1: like ligament surgeries to run in the twenty to thirty
13:33
Speaker 1: to forty grand range at a hospital all in, and
13:37
Speaker 1: then at a surgery center sometimes you know, five to ten,
13:41
Speaker 1: so huge, ten versus thirty is wildly different. Yeah, that
13:48
Speaker 1: that happens all throughout the US. That's extraordinary. Let's just
13:52
Speaker 1: let's just sit in that for a sec right, Like,
13:54
Speaker 1: I know we're used to healthcare blah blah blah, but
13:57
Speaker 1: like that's that's out of control in some way, Like
14:00
Speaker 1: that shouldn't persist. That doesn't make sense and why why
14:05
Speaker 1: why has that persisted until now? I mean, it's part
14:08
Speaker 1: of it market power? Is it that you know a
14:10
Speaker 1: lot of places there's basically one hospital and so the
14:15
Speaker 1: insurance company kind of has to pay what the hospital
14:17
Speaker 1: asks because it's the only hospital. That's a huge part
14:20
Speaker 1: of it. That's probably the main driving thing. It's just
14:23
Speaker 1: market power and no other options. So it's kind of
14:27
Speaker 1: an antitrust problem. Although if you recognize the surgery center
14:30
Speaker 1: as part of the market, then like there's a solution.
14:34
Speaker 1: You don't have to go to the hospital. There is
14:36
Speaker 1: a competitor. Well, that is the problem. How easy is
14:39
Speaker 1: it to affect change in the market, Like how easy
14:43
Speaker 1: is it for a top orthopedic surgeon to open a
14:47
Speaker 1: surgery center and to move out of the hospital environment.
14:50
Speaker 1: And it's that a regulatory question. Is it a sort
14:53
Speaker 1: of access to capital question? Like what affects that? It's
14:57
Speaker 1: all the above, regulatory access to capital, comp practice privileges.
15:03
Speaker 1: You know, once you're out, you're out, like forget about
15:05
Speaker 1: you can't if the hospital says if you go open
15:08
Speaker 1: a surgery center, you can't admit patients to the hospital.
15:10
Speaker 1: Anymore they do. Yeah, oh yeah, that's definitely a thing.
15:13
Speaker 1: So how easy is it for this side of service
15:16
Speaker 1: shift to occur? And so there are a bunch of barriers,
15:20
Speaker 1: and I think price transparency forces will work to you know,
15:24
Speaker 1: be down those barriers. Okay, but really, really, what is
15:35
Speaker 1: it going to take to get to a world where
15:38
Speaker 1: we know what a trip to the hospital is going
15:40
Speaker 1: to cost before we go to the hospital. That's coming
15:44
Speaker 1: up after the break. Now back to the show. What's
15:51
Speaker 1: the thing you haven't figured out how to do yet?
15:53
Speaker 1: What's like a problem you've been kind of working on
15:55
Speaker 1: but you feel like you haven't really cracked yet. So
15:59
Speaker 1: there's two big ones. One is how do we convince
16:06
Speaker 1: and or enable the providers and payers to agree to
16:12
Speaker 1: an upfront price for healthcare? So a hard problem we're
16:17
Speaker 1: working on is for your average insured patient to give
16:20
Speaker 1: them an upfront binding price that the hospital and the
16:23
Speaker 1: insurance company will stand by. And there's a new rule
16:27
Speaker 1: coming that seems relevant, right where the kind of the
16:30
Speaker 1: explanation of benefits that you get after you go whatever
16:34
Speaker 1: to the doctor, you're supposed to be able to get
16:36
Speaker 1: that before you go, Right, that's like a thing that's coming.
16:39
Speaker 1: Is that relevant here, Yeah, And that is a huge
16:42
Speaker 1: complexity ahead of us, and it's still dependent on new
16:45
Speaker 1: rulemaking coming out of the government any day. I mean,
16:47
Speaker 1: it's probably like there is some amount of actual complexity
16:51
Speaker 1: in healthcare where like the body is complicated. They don't
16:54
Speaker 1: know what's going to happen, Like there's a reason, you know,
16:58
Speaker 1: especially if somebody's really sick, they got a lot of
17:00
Speaker 1: things wrong with them. The hospital doesn't know what's going
17:02
Speaker 1: to have to happen, Like I feel like there's cases
17:04
Speaker 1: where they in good faith don't know totally and it
17:08
Speaker 1: just comes. This is where actualaries come in the law
17:11
Speaker 1: of large numbers. If one person comes in for that
17:15
Speaker 1: nimniscus repair and they have some comorbidities, turns out there
17:18
Speaker 1: in the operating room an hour longer than planned, that
17:22
Speaker 1: could be a loss for the surgery center of the hospital.
17:25
Speaker 1: But if a hundred patients come in, then you know,
17:27
Speaker 1: ninety out of one hundred will follow a similar cost structure,
17:31
Speaker 1: and so they should be able to promise to charge
17:33
Speaker 1: some average rate that over time is the right price
17:36
Speaker 1: at which they can run their business at a profit. Yeah,
17:38
Speaker 1: and that's happening in some places, but it needs to
17:41
Speaker 1: happen in more to create that kind of coverage of
17:43
Speaker 1: the market. Like we've discussed. Okay, so that's one, what's
17:47
Speaker 1: the other. The other is pretty much the same problem,
17:51
Speaker 1: but more to B to B level. How do we
17:54
Speaker 1: create a binding, easy to reconcile payment between the insurance
17:59
Speaker 1: company and the hospital, Because that's where a lot of
18:01
Speaker 1: the waste happens in healthcare, is the billing and claim
18:07
Speaker 1: adjudication mumbo jumbo that goes on between those two entities.
18:12
Speaker 1: That's way more than with patients. Right, Presumably the vast
18:14
Speaker 1: amount of money and healthcare is not going from a
18:17
Speaker 1: patient's wallet to the hospital. It's going from the insurance
18:20
Speaker 1: company to the hospital. Yeah, the lion's share of the
18:22
Speaker 1: waste here that affects our GDP and our premiums and
18:26
Speaker 1: our salaries is coming through that B to B transaction.
18:30
Speaker 1: And so tell me about like in a way it's surprising.
18:33
Speaker 1: I mean, if you know about healthcare, it's kind of
18:35
Speaker 1: not surprising, but sort of naively it's surprising because you
18:38
Speaker 1: would think, oh, insurance companies are giant and hospitals are giant,
18:41
Speaker 1: and they do so many of these procedures. What's the
18:43
Speaker 1: problem there. I'll give you an example hopefully that helps. Yeah,
18:49
Speaker 1: often if you go in for that nimniscus repair, a
18:55
Speaker 1: few other things might happen. They might clear out some
18:58
Speaker 1: other cartilage. At the end of the day, you might
19:01
Speaker 1: end up with three different procedures build on your claim.
19:04
Speaker 1: And if there's any issue with the claim and what
19:08
Speaker 1: you end up with our people like me in the
19:11
Speaker 1: last ten years, well, we'll go through in data mind
19:13
Speaker 1: and find those discrepancies and charge a fee and sort
19:18
Speaker 1: of push these reconciliations back and forth for years after
19:22
Speaker 1: the fact. So, just to be clear, what you wind
19:25
Speaker 1: up with is the hospital and the insurance company negotiating
19:29
Speaker 1: on a case by case basis, people at both places
19:33
Speaker 1: getting paid to It's kind of like going to court.
19:35
Speaker 1: They're not going to court, but they're arguing over like
19:37
Speaker 1: did you do this one procedure on this one patient
19:40
Speaker 1: this one day. That's what you're talking about. It's exactly that.
19:42
Speaker 1: And what ends up is this really long, honestly years
19:45
Speaker 1: long process where these case by case reconciliations are happening,
19:49
Speaker 1: which is wildly expensive, right, and we end up paying
19:52
Speaker 1: for that in our health insurance premiums huge industry and
19:56
Speaker 1: we don't benefit from that. Like, it would be great
19:58
Speaker 1: to get rid of that. It would be an efficiency
20:00
Speaker 1: gain that would lower healthcare prices. Yeah, So how do
20:04
Speaker 1: you get rid of that super costly back and forth?
20:07
Speaker 1: That's a good, big problem. Do you get rid of that?
20:10
Speaker 1: That's the hard thing I guess is this is an
20:13
Speaker 1: industry that's slow to adopt new software. They're setting their ways.
20:17
Speaker 1: It's very difficult. I think that's one of our biggest
20:19
Speaker 1: problems ahead of us if we want to simplify this
20:21
Speaker 1: payment and healthcare is you can't just build that future solution,
20:26
Speaker 1: but you've got to build the steps to get there. Okay, Yeah,
20:29
Speaker 1: that's a big part of what our team's working on.
20:30
Speaker 1: Baby steps, Baby, baby steps. So's the what's like, what's
20:35
Speaker 1: the middle ground? I get the end is it's just
20:37
Speaker 1: software and there's no people whose job is arguing over
20:40
Speaker 1: mindy repair, right, But what's what's the step between here
20:43
Speaker 1: and there? The middle ground for both of those problems.
20:47
Speaker 1: You know, the patient payment and the B to B
20:49
Speaker 1: payment is enabled by this new law that takes effect
20:56
Speaker 1: essentially in twenty twenty three. We're still waiting for guidance.
20:59
Speaker 1: And it's a piece of No Surprises, the No Surprises Act,
21:03
Speaker 1: and you mentioned it earlier. If that says you are
21:05
Speaker 1: entitled to a good faith estimate in advance of care, okay.
21:10
Speaker 1: If that estimate of your cast share ends up being
21:15
Speaker 1: off by a certain amount four hundred dollars the amount
21:18
Speaker 1: currently proposed, then you as a patient have recourse to
21:23
Speaker 1: reconcile that and to argue it, dispute it. Meaning you
21:26
Speaker 1: might not be on the hook. You might not be
21:28
Speaker 1: on the hook for the big bill that you were sent.
21:30
Speaker 1: And so that presumably gives everybody in the system an
21:35
Speaker 1: incentive to come up with a number in advance and
21:38
Speaker 1: stick to it and not argue about it after exactly
21:42
Speaker 1: let me ask you. Let me ask you one. There's
21:45
Speaker 1: kind of a subtext here for me. I mean, really,
21:47
Speaker 1: what we're talking about is bringing market forces to bear
21:53
Speaker 1: on healthcare to make healthcare more efficient than better, which
21:57
Speaker 1: makes sense in a certain way of thinking. I do wonder.
22:01
Speaker 1: I mean, clearly, there are a lot of things where
22:03
Speaker 1: the market works great. It does seem like healthcare is
22:06
Speaker 1: a place where there are a bunch of reason to
22:09
Speaker 1: think market forces might not work great. Even if we
22:12
Speaker 1: set up the market better. Right, patients are scared, they
22:15
Speaker 1: trust their doctor. It's intermediated by insurance. And so I
22:20
Speaker 1: don't know if this question is like too big, but
22:22
Speaker 1: does it even make sense to try and make the
22:25
Speaker 1: market work in healthcare? I would argue by saying that
22:31
Speaker 1: the consumer can decide if they if this is worth
22:34
Speaker 1: it for them to make a change. So an example is,
22:36
Speaker 1: if you love your doctor and you care about your
22:39
Speaker 1: health or your family member's health, it is your right
22:42
Speaker 1: to decide if that is worth more to you. And
22:45
Speaker 1: maybe the drive to get there is worth more to
22:47
Speaker 1: you than the five thousand dollars you can save. And
22:49
Speaker 1: so maybe what the market forces in healthcare how they
22:51
Speaker 1: differ is just that it will take more for there
22:55
Speaker 1: to be a change of the consumer decision or the
22:59
Speaker 1: purchase or decision than it does in other industries. Right,
23:02
Speaker 1: It's not like an airline where if one airline is
23:04
Speaker 1: twenty five bucks less, like sure, I'll fly on that airline.
23:07
Speaker 1: It's not exactly. There's a bun of qualitative things that
23:10
Speaker 1: come in around. If you trust your doctor, if you
23:12
Speaker 1: feel you're cared for, that make it a slightly different market,
23:16
Speaker 1: but not entirely in a minute, the Lightning Round, including,
23:23
Speaker 1: among other things, how to talk to your doctor about
23:26
Speaker 1: how much something is going to cause. That's the end
23:35
Speaker 1: of the ads. Now we're going back to the show. Okay,
23:38
Speaker 1: almost done. Last thing we're going to do is a
23:40
Speaker 1: lightning round. Great. What's another domain where pricing is opaque
23:46
Speaker 1: that would benefit from more transparency? Well, you know this
23:49
Speaker 1: is this is interesting, but I've had price transparency as
23:53
Speaker 1: a Google alert for years, and I have seen the
23:58
Speaker 1: other industries where this is a hot topic cattle, agriculture,
24:02
Speaker 1: and foreign currencies, foreign exchange markets. Yeah, it's like a
24:07
Speaker 1: recurring thing. Those three things come up. Agriculture meaning like
24:11
Speaker 1: wheat or what like I don't even know what that means. Yeah,
24:13
Speaker 1: various produce. And I've collaborated this by asking a few
24:17
Speaker 1: friends in those industries like, hey, keep getting these alerts,
24:19
Speaker 1: this is a problem. They're like, oh, yeah, you should
24:23
Speaker 1: fix that once you fix healthcare. Good. Those are not
24:26
Speaker 1: three I would ever have guessed that's interesting. Do you
24:29
Speaker 1: might think you might fix those once you fix healthcare? No.
24:33
Speaker 1: I think what's more reasonable is there are other countries
24:36
Speaker 1: that have a very similar problem where private insurance and
24:40
Speaker 1: providers follow the same kind of archetype that we do
24:43
Speaker 1: in the US that I'd be curious, like ten years
24:45
Speaker 1: down the road if some of the stuff could work
24:47
Speaker 1: in other countries. Ah, So not doing something else in
24:50
Speaker 1: the US, but doing healthcare pricing in other countries. Exactly
24:54
Speaker 1: from working in healthcare pricing and revenue, what have you
24:59
Speaker 1: learned about pricing and negotiation that's helpful to you, you know, personally,
25:03
Speaker 1: say in other domains? In other domains, Yeah, like you
25:09
Speaker 1: good when you like go to buy a car or
25:11
Speaker 1: you know, I honestly it's not another domain. But I
25:16
Speaker 1: can help anybody in my family and myself know the
25:20
Speaker 1: price of care in advance, because right now in healthcare,
25:24
Speaker 1: it takes a lot to figure it out. So like
25:26
Speaker 1: one superpower is that I feel like I'm able to
25:29
Speaker 1: navigate costs and healthcare maybe before other people are quite ready.
25:35
Speaker 1: You get a lot of like calls from your family
25:37
Speaker 1: all the time and just walk through like, hey, here's
25:39
Speaker 1: the best worst case scenario for you to plan for,
25:43
Speaker 1: and here's some things to ask your doctor as you're
25:45
Speaker 1: going through that process. Yeah, it's weird when you ask
25:49
Speaker 1: doctors about pricing. Often they don't want to talk about
25:53
Speaker 1: it in my experience, or they don't know. Yeah, So
25:56
Speaker 1: the way you ask a doctor about pricing is less
25:58
Speaker 1: how much does this cost? And more of do I
26:01
Speaker 1: really need this right now? Or could this wait five
26:03
Speaker 1: days for me to go to that you know, imaging
26:05
Speaker 1: center or somewhere else to get this done. That's a tip.
26:09
Speaker 1: You snuck a tip in, and I appreciate snuck a tip.
26:13
Speaker 1: If everything goes well, what's a problem you'll be trying
26:15
Speaker 1: to solve in five years? If everything goes well. So
26:22
Speaker 1: for us, what that means is that it's as easy
26:24
Speaker 1: to know the price of healthcare as it is buying
26:26
Speaker 1: a toaster on Amazon. If everything goes well, the next
26:30
Speaker 1: problem is really making sure we have all the right
26:34
Speaker 1: data in front of the patient. So not just price,
26:38
Speaker 1: but the quality is still a big issue. Accessibility, So hey,
26:43
Speaker 1: can I have this in three days or do I
26:45
Speaker 1: have to wait two months? And so there's all these
26:47
Speaker 1: other we call them like pillars of the healthcare value
26:50
Speaker 1: proposition that we want to tackle in price. It's just
26:53
Speaker 1: where we're starting. Chris Severn is the co founder and
27:02
Speaker 1: CEO of Turquoise Health. Just a quick note, this show
27:06
Speaker 1: what's Your problem is going to take a two week
27:08
Speaker 1: high US. We will be back on Thursday, September twenty
27:13
Speaker 1: ninth with more shows. Today's show was produced by Edith Russolo.
27:17
Speaker 1: It was edited by Robert Smith and engineered by Amanda
27:21
Speaker 1: ka Wong. I'm Jacob Goldstein and we'll be back later
27:25
Speaker 1: this month