Hartford Business Journal

38 Hartford Business Journal • decemBer 26, 2016 www.HartfordBusiness.com Q&A Cost transparency coming into sharper focus Q&A talks with Robin Gelburd, founding president of FAIR Health, a New York- based nonprofit that aims to advance healthcare cost transparency. Q: With a grant from the Con- necticut Health Foundation, FAIR Health (FH) in Septem- ber launched a free mobile app called FH Cost Lookup CT, which allows consumers to view zip-code specific pricing data for a wide array of medi- cal billing codes. What sorts of health consumers benefit the most from such an app and why? A: Research continues to show that most Americans, particularly Hispanic consum- ers and the newly insured, lack the necessary understanding of health insurance to make informed decisions when selecting a plan, provider or treatment. Yet, consumers are also responsible for an increas- ing portion of health costs. Uninsured consumers can use the app, which offers both English and Spanish options, to better understand the "value proposition" of health insurance by estimating their costs for needed services with and without coverage and to estimate their medical and dental expenses for services they will receive, and negotiate their costs beforehand. Insured consumers can use the app to estimate their healthcare expenses before receiving care to decide whether to go out of network or stay in network. After receiving care they can use the app when reviewing billing forms to decide whether to appeal a reimbursement decision. Q: The cost information in the app is based on claims data submitted to FH by insurers, which have been averse to pub- licly disclosing their contracted pricing with providers. Why do insurers share this data with your company? A: There are many reasons why more than 60 payers and administrators cover- ing more than 150 million individuals con- tribute data to FH, which is recognized as an independent, trusted steward of medi- cal and dental claims. First, they receive credits that reduce the licensing fees for the data products, custom analytics and detailed reports they license from FH. They also receive valuable feedback on the quality of the data they submit. All data submitted gets subjected to robust auditing and valida- tion processes at FH. Moreover, contributors recognize the public service of contributing to the FH data repository. By submitting claims to FH, a contributor ensures that its experience will be represented in a database that is used by payers and all other stakeholders in the healthcare industry nationwide. Q: A "menu" of healthcare prices in every hospital and doctor's office seems unlikely in the near term, but the private sector has sought to step into the space. In Connecticut, Anthem offers Castlight software to show pricing and quality data to its members. Aetna has a payment estimator tool for its members that shows negotiated rates. Where does FH fit into this broader picture? A: Some insurers license FH data for use in their mem- ber-cost calculator tools. Others "private label" our website, which allows them to capitalize on the value of our data and educational resources while maintain - ing their own brand and logo. Still others license a link to our site so that their members can benefit from the informa- tion we offer. Some plans even license our consumer tools to serve as a resource for their customer-service representatives as they interface with members and field questions and inquiries. FH data also feature prominently in healthcare consumer protection laws in New York and Connecticut. In Connecti- cut, consumer protection laws require insurers to use the FH 80th percentile as the 'usual, customary and reasonable' standard for payments for out-of-network emergency services. Many other states that are considering similar legislation are speaking with FH about its data. Finally, the FH repository is effec- tively a multi-payer claims database that contains data from major insurers nationwide, including self-insured plans, and features the largest collection of pri- vately billed medical and dental claims data nationwide. Q: What do you think the future holds for price transparency in health care? A: While price transparency is a critical starting point for driving improvement in our healthcare system, we also will need clarity to effect real change. Clarity involves making price data actionable by adding the needed context to support decision making for all stake- holders, including payers, plan sponsors, purchasers, researchers, practitioners and consumers. n 2017 HEALTH CARE OUTLOOK Q&A Competition grows in bone and joint care Q&A talks with Elliot Joseph, CEO of Hartford HealthCare. Q: Hartford Hospital's $110-mil- lion Bone & Joint Institute opened in December. Who will you be competing with and how will the new facility advance ortho- pedic care in Connecticut? A: It's not who we're competing with, it's who we're competing for. We're compet- ing for patients who want and need the full depth of orthopedic and joint-health spe- cialties, from sports medicine to injury prevention to activity- specific rehabilitation and, of course, many forms of surgery. This facility is the newest, most innovative and most com- prehensive stand-alone center in the entire U.S. It's got a world- class medical team, a unique, multidisciplinary musculo- skeletal approach and a world- class facility. It takes its place among the country's best free- standing specialty hospitals. Q: What does the new facility mean for the cost of these types of health- care services in our area? A: At Hartford HealthCare, we have been adopting Lean organizational prin- ciples and techniques throughout our organization. We have trained — and continue to train — our managers in the use of Lean as part of our performance quality and innovation platform, which we call 'How Hartford HealthCare Works.' It's really the culture of our entire organization and it means working every day to make health care better and more efficient for every- one, our patients and families. The Bone & Joint Institute at Hartford Hospital is the first facility that we have designed with Lean principles in mind. It is probably one of the few healthcare facili- ties in the nation created in this way. While this doesn't immediately trans- late into affordability, as healthcare costs are affected by many factors, we believe that it will. We know that our focus on pre- vention, with the state-of-the-art motion lab and other services, will help avoid both serious injuries and also the higher costs of treating those injuries. And we expect the new facility, over time, to pioneer new efficiencies in ortho- pedic care that will ultimately result in greater affordability for patients. Q: What partnerships has the Insti- tute formed with companies or other providers and what do they entail? A: The partnerships involved in cre- ating and sustaining this one-of-a-kind facility are too numerous and complex to describe briefly. But I can say what it all adds up to: economic development. This is a perfect example of how investment can grow the state's economy. Designing, constructing and outfit- ting the building involved more than 80 companies, including many small and mid-sized firms that supply everything from furniture and telephones to medical technology. Our main partner in the Bone & Joint Institute is Orthopedic Associates of Hartford, with nearly a half-century of experience in the full range of ortho - pedic care. Beyond that, we are tap- ping into the expertise of our own member organizations, such as the Hartford Hospi- tal Rehabilitation Network and other specialists. We also will partner for research with our Center for Educa- tion, Simulation and Innovation (CESI), which we are expanding. CESI has a range of partnerships with biomedical and biotech firms for testing, training and evaluation. These partners include such compa- nies as Intuitive Surgical and Stanley Black & Decker. Making wise invest- ments and working with the right part- ners produce advances in patient care. This approach also helps the state's healthcare industry grow as an econom- ic engine and laboratory of innovation. Q: How will Hartford HealthCare measure success in 2017, the Insti- tute's first full year in business? A: We will measure success at our Bone & Joint Institute at Hartford Hospital the way we measure success across Hartford HealthCare: one patient at a time. Of course we have targets for num- bers of patients served and we also want to ensure that everything we do in the new facility touches the work of provid- ers and the lives of patients across our system and across Connecticut. But it comes down to each encounter with every patient — whom we see, truly, as customers. We want to do everything we can to keep them mobile and healthy and happy with the care they receive. n ROBIN GELBURD Founding president of FAIR Health ELLIOT JOSEPH CEO of Hartford HealthCare Health Care

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