The Transparency Advantage
Price transparency is a new, groundbreaking way of delivering healthcare.
In practice, transparency needs little more than telling patients what the cost of a procedure will be. The simplicity frees treatment from the cost and complexity that has become business-as-usual in healthcare.
Transparency is empowering to patients and payers in that it reveals prices which are central to the healthcare equation. Similarly, it requires providers to offer their services for a realistic fee, one that is tied to the actual cost of providing treatment.
We estimate that OSC fees—cost plus reasonable compensation—are on average 40 to 60 percent of the money that changes hands at in-network coverage rates and a mere fraction of most hospital’s full price. In California, the average hospital fee for a total hip replacement, not including incidentals, is upwards of $85,000 in 2012. At OSC, the same procedure price tags at $23,815.
Two of the entries below outline what the prime benefits of transparency are, as they pertain to the patient and physician, respectively. And, in recognizing that a large number of Americans receive coverage through an employer-sponsored arrangement, the third entry addresses the gains, including added savings, that accrue to self-insured employers who opt to plug-in to the model.
The leading priority for patients is the assurance that the treatment received is guided by the medical factors. But today, far too many non-medical priorities come into the medical equation and undermine the cornerstone that is the patient-physician relationship.
We often refer to the transparency model as “direct care”.
Direct care means that interaction between a patient and their chosen physician will not be infringed upon and that a patient’s wellbeing will not be subject to an administrative rollercoaster.
Efficiency and the elimination of waste lead to savings for those shouldering the burden of medical costs, and prices quoted prior to treatment eliminate surprises and allow patients to plan ahead.
Doctors understand the administrative rollercoaster—the chronic iterations of denial, delay, and appeal—all too well.
Price transparency, however, works around the uncertainties. The price is shared with the patient, and the patient in turn issues a payment accordingly. All of which happens prior to treatment.
Medical staff—physicians, anesthesiologists, RNs, and CSTs—are reimbursed on the day of surgery. And by doing so, we successfully demonstrate that the rollercoaster ride, like high prices, is entirely unnecessary.
Self-insured employers have already taken a significant step in reducing healthcare spending by assuming all or part of healthcare claim risk. But while self-insurance can effectively rein in the cost of providing coverage, the self-insured employer remains exposed to high-priced healthcare—coverage and care being distinct from one another.
This is true even despite their administrative arrangement granting users in-network privileges and rates. In-network rates are themselves hidden and may or may not be correlated with the cost of providing treatment, which also explains why costs can vary, almost randomly, from one provider/facility to the next.
To facilitate a self-insured employer’s access to the model, OSC works with their benefit administrators to tailor this package as an out-of-the-box, add-on to a working plan. This allows employees who opt for the OSC route to do so without disturbing their coverage or any existing arrangements they have made with their primary plan.