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How much health insurers pay for almost everything is about to go public

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Re: How much health insurers pay for almost everything is about to go public

#171

Post by antisthenes »

whatshisface wrote: post #165
snarf21 wrote: post #122

Earlier quoted context omitted.

We really need to move to reference based pricing. We can cut so much waste out of the current system including brokers. Reference based pricing also get rids of the loopholes for things like anesthesiologists being "out of network" at a hospital/facility that is "in network". It also gets rid of the situation where if you offer cash you get one price but if you submit for the same code, it could be 3x or 10x or even…

What's reference-based pricing?

It's basically price-controls.

A regulatory body looks at how much something "should" cost based on its history of reimbursement and the cost of its inputs and then sets a cap of say, cost + 20%.

The problem is having an independent body that is free of influence of health insurance companies and hospitals, both of which have perverse incentives to continue profiteering.

Re: How much health insurers pay for almost everything is about to go public

#173

Post by antisthenes »

ageitgey wrote: post #2

I'm one of the co-founders of Turquoise Health, mentioned in the article here. We've been downloading and parsing this data all day. It's a really big deal in the industry that the prices that insurance companies pay doctors are now being shared publicly. It will have all sorts of positive impacts over time, hopefully making rate negotiations more consistent and fair between different insurance plans. Right now, 10x…

Are you guys hiring?

Re: How much health insurers pay for almost everything is about to go public

#174

Post by sib »

pastor_williams wrote: post #169
zdragnar wrote: post #46

Earlier quoted context omitted.

They likely had lenses already available for the frames they had in stock, or were frequently making batches of them. OTOH the frames you already owned may be out of style, so they would have needed to grind a totally custom pair of lenses, just for you.

This doesn't work as an explanation, lenses are always cut to the frame. My brother in law owned a lens cutting shop and they have boxes filled with lenses ground to all sorts of prescriptions that are circular plugs 3 or 4 inches in diameter. When the order comes in they use the pupil measurements and the frames to cut the lenses for the prescription down to fit into the frame. I don't know how well I explained that…

Thanks for this explanation - makes complete sense but never thought about it!

Re: How much health insurers pay for almost everything is about to go public

#175

Post by sib »

lostcolony wrote: post #65
zdragnar wrote: post #46

Earlier quoted context omitted.

They likely had lenses already available for the frames they had in stock, or were frequently making batches of them. OTOH the frames you already owned may be out of style, so they would have needed to grind a totally custom pair of lenses, just for you.

Nah. Outside of the vision cartel you can get replacement lenses for any pair of frames < $100, with all the various coatings and special shit for low hundreds. Likewise, using insurance to just replace the lenses, if a plan includes that, is often $50 or less. It's just shopping at the vision cartel without insurance = huge sticker price.

Any tips for how to stay "outside the vision cartel"? (In the US, if that is relevant...)

Re: How much health insurers pay for almost everything is about to go public

#176

Post by treis »

31835843 wrote: post #164
CoastalCoder wrote: post #5

I'm curious if this is a first step towards hospitals being required to charge the same prices to everyone, insured or otherwise.

This seems so sensible to me that I’m curious why the hell it wouldn’t work.

Which price and who determines it?

Re: How much health insurers pay for almost everything is about to go public

#178

Post by dwaltrip »

akira2501 wrote: post #143
elromulous wrote: post #94

Earlier quoted context omitted.

Could this backfire - similarly to how publicly traded companies' CEOs disclosing their pay caused their pay to skyrocket?

That's an odd way to look at it, as a "backfire." We're introducing more information into the market. If some prices went up as a result, isn't that an indication that the lack of pricing information was being used to artificially depress prices? If so.. this isn't a "backfire" so much as an "obvious and necessary correction?"

Based off some of the other comments, here is the idea I’m picking up on:

If a particular market isn’t that competitive and has oligopolistic aspects, more transparency may increase the “effectiveness” of the oligopoly. Instead of hospitals that were charging more lowering prices to compete, we could see hospitals that were charging less raises prices because they know the competitive pressures are weak and they don’t want to leave money on the table.

Seems plausible to me, depending on how oligopolistic most hospital markets are.

Re: How much health insurers pay for almost everything is about to go public

#179

Post by snarf21 »

whatshisface wrote: post #165
snarf21 wrote: post #122

Earlier quoted context omitted.

We really need to move to reference based pricing. We can cut so much waste out of the current system including brokers. Reference based pricing also get rids of the loopholes for things like anesthesiologists being "out of network" at a hospital/facility that is "in network". It also gets rid of the situation where if you offer cash you get one price but if you submit for the same code, it could be 3x or 10x or even…

What's reference-based pricing?

The sibling is right but in this case we'd probably do something like Medicare + 20%, which is actually close to what most insurers do for some of the codes already. It just removes the cost of negotiation, brokers, out of network, etc. and actually lets you know the cost up front for most appointments. We also need to get rid of service levels for most appointments. It is just used as an excuse to up charge by having patients fill out pointless paperwork. We also need to reimagine our service provider models. We have already move to CMAs to take blood pressure, etc. We also need to move to PA or LPN instead of a Dr for most cases. Ear infections, colds, flus, etc. are a majority of family appointments and can be handled by lower levels. The Dr can then review cases and deal with the more complicated cases where her expertise is most needed.

Re: How much health insurers pay for almost everything is about to go public

#180

Post by gnopgnip »

Olreich wrote: post #4

> “What we’re learning from the hospital data is that insurers are really bad at negotiating” Do the insurers have any incentive to negotiate well? Since their customers are not very price-sensitive (since they aren't marketing directly to patients or doctors), I would imagine they don't have a huge incentive to do anything but apply a markup to whatever prices the hospital tells them it costs.

Health insurance customers are price sensitive
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