You know there’s something inherently wrong with American healthcare if a veteran reporter with the New York Times can’t get an explanation from her insurance provider about why she was charged $1,419 for an intraoperative medication she could get online for $2.47.
Journalist Jeanne Pinder became increasingly perturbed after finding out the high co-pay fell squarely on her shoulders, and she set out to investigate. She embarked on a complicated series of phone discussions with the hospital’s billing office, the insurance company, and her employer—conversations that led her nowhere.
After that, “maybe there was something to be said for a measure of transparency,” she explains. “I’ve always thought that it was odd that the sticker price (the billed price) and the actual price that’s paid by the insurance company are different. Opportunities for explanation are thin to none—and your ‘explanation of benefits’ (insert heavy air quotes here)—explains absolutely nothing.”
With this in mind, she took a buyout from the Times in 2009, and within a year, received $20,000 in grant money to seed ClearHealthCosts. The company, which has been called the Kayak.com of healthcare pricing, is a web-based space where you can compare prices on procedures like IUD insertion, STD testing, and ultrasounds.
I felt covering Pinder and the ClearHealthCosts concept of “democratizing” health information was the perfect way to close our series on female founders, as it offers an exciting glimpse of a less “opaque” future of healthcare. Sit back and I’ll introduce you to the woman who’s putting some power in your hands.
Besides your own experiences, were there other driving forces that spurred you to create the company?
The more I started to talk about [my frustration in finding the true cost of my medication] with other people, they said, “Oh yeah, I’ve had a similar experience.” The question of finding out what stuff costs in healthcare really resonates with people.
And at the same time [we were starting the company], we had yet another president staking his presidency on resolving the healthcare problem and a number of public and private figures saying that this is the biggest problem we have in our budget. It is a huge deal for this country in economic and social terms—it’s the biggest problem I think we face as a nation.
Who do you see getting the most use out of ClearHealthCosts?
The problem that we’re trying to solve is that no one has any idea what things cost in healthcare. We have this marketplace where none of these numbers really have a relationship to each other. The people who are most interested in this information tend to be people who are uninsured or on high deductible plans.
Increasingly, there is also a desire on the part of the employer or insurers to institute a plan that involves more “skin in the game” [or money out of pocket] for the insured person—that might be 10% of the sticker price or a 20% co-pay on the sticker price, which is increasingly common here in NYC.
So people are asking [about what procedures cost] in different ways. Sometimes they are asking online, by Googling, “How much does an MRI cost?” or “How much does a colonoscopy cost?” We’re finding that the conversation might not be taking place between the provider and the patient—but that people still want to know.
Where does the pricing information come from?
We’re getting our information from a number of different places, including “shoe leather reporting” (hand collecting information), surfing of databases, database visualization, and interactivity. We’re also doing phone reporting, blogging, interweb reporting, and crowdsourcing.
We also give you comparison information on the Medicare prices—so we’ve done some database sourcing and curation to find out the government reimbursement. That’s the closest thing to a fixed or benchmark price in this marketplace.
Do you think bringing transparency and the ability to comparison shop for medical procedures to patients will drive down healthcare costs overall?
It’s happening already. Think about the prescription drug plans that Target, Walgreens, A&P, and Kroger offer—some plans offer generics for as little as $4 a month, depending on the prescription.
There are also providers that are competing on cash. We see a lot of action here [in NYC]—you see a lot of urgent care retail clinics in drugstores, sort of replacing, augmenting, or supplanting the typical primary care provider. That is an extremely competitive part of the marketplace, and it’s exploding here.
So would you say ClearHealthCosts is on a mission of sorts to change the face of healthcare?
If we can do that—we will have done a great thing. You can look at any number of levels in the system—for example, look at the individuals making unpowered decisions about their healthcare because they can’t afford it. It’s a huge human cost, this problem. Not that I think that ClearHealthCosts is going to figure that out tomorrow, but resources are being misallocated or misdirected and that’s a really big social issue we should face.
Have you found the healthcare community resistant to publishing healthcare costs online?
Generally, it’s been hugely positive—I had not expected that sort of warm welcome. But I think that healthcare is in revolt. Think about the way that marketplace forces are at work—legislative, judicial, and political forces, the election that just finished, and the Affordable Care Act—and put this together with people that came into this profession to heal and are looking at this wasteland of misaligned monies. I may be taking this a bit far, but I really believe that everyone in this industry thinks the payment system is a mess and something needs to happen.
What’s one essential quality for any new healthcare entrepreneur?
I think it’s a marketplace with a lot of accepted wisdoms, and it’s really important to be able to challenge that accepted wisdom when venturing in. I do think on some level, coming to this discipline without a deep background in healthcare is a blessing. I could be totally wrong about that, because I know people who are in healthcare. But, the willingness to ask naive questions is really important.