The Dish on Health IT

Price Transparency: Pharmacy & Medical. What's Next?

Episode Summary

This episode tackles the challenges of price transparency in healthcare...because...well, it's complicated. Carm Huntress, CEO of RxRevu, joins hosts, Gary Austin and Pooja Babbrah to talk about the progress that's been made and the work still left to be done to achieve real price transparency in healthcare.

Episode Notes

Carm Huntress, CEO of RxRevu, joins hosts, Gary Austin and Pooja Babbrah to discuss price transparency. 

Gary asks Pooja to start the discussion with a primer for price transparency. Pooja states that the topic itself is quite complex and, unfortunately, not very transparent. When receiving a prescription from your doctor, you never really think to ask if you should go to a different pharmacy or if there are coupons available for the medication. You simply pick up the prescription and pay the price that is due. Additionally, since the price of medications are going up, many patients do not pick up prescriptions because they are too expensive. Patients cannot afford to pay for them. Pooja explains that when we think about price transparency, it is all about being transparent with the consumer, letting them know what prescriptions and procedures are actually going to cost them out-of-pocket.

Gary then asks Carm to briefly go over RxRevu and to give some opening comments about price transparency. Carm shares that RxRevu is a Denver based company focused on price transparency around drugs. The company helps providers at the point of care make cost-effective decisions by providing a large amount of information. Carm says on a monthly basis, RxRevu is helping millions of patients around affordability issues with their prescription drugs.

There is a recent CMS ruling requiring hospitals and payers to post their charges online. Gary asks Carm what all of this means for consumers. Carm says the big idea of this ruling is directionally right. Healthcare is really the only industry where consumers don’t know the price of products and services before they buy them. Carm explains that the problem with price transparency is that there’s so much complexity in actually pricing medications and procedures, especially since negotiations are affecting these prices. 

Pooja says this ruling was an important step forward. There’s a list of 300 items hospitals and payers are required to give pricing on. She notes that it may not be easy for them to offer this information and the timing for when they actually provide a complete list may be far into the future. 

Gary points out that price transparency sounds like a good thing for consumers, but what about the physicians? Gary asks Carm if the availability of this information will really change physicians’ prescribing and referral habits. Carm explains that price transparency thoughtfully puts the right type of information into workflow, including what the patient will pay at their preferred pharmacy, types of lower cost therapeutic alternatives and insurance coverage. Carm states early findings show that one in every five doctors who are presented with this information make a cost-dynamic change.

Prescription price transparency is moving along faster than medical procedure transparency, is that a fair observation and if so, why? Carm agrees with Gary and believes this is the case because the need for price transparency in pharmacy has been driven harder given the longevity of the idea. He says the claims system and the engines that we talk to in terms of getting the data out are a little less complex than on the medical side. The PBMs and the systems behind the PBMs were more ready to do real time benefit and that’s why it came to market and matured faster. 

Gary asks Pooja what’s going to be the tipping point for price transparency across the industry. Is there some event or some thing that will be a tipping point as we look out a year? Pooja thinks that from the PBM to the physician standpoint, we’re almost there, but in order to progress further, we need to incorporate the consumer side. Doctors can’t be price shopping for consumers all the time, so that’s where we bring in the second piece of consumer-facing price transparency.

RxRevu is growing exponentially. What is your company doing better, faster, or cheaper than the next guy with price transparency? Carm explains price transparency is the company’s singular focus, which allows them to execute at a high level. RxRevu works alongside clinicians to finetune those transactions to make sure they go through clean and with the best experience possible. Secondly, Carm notes the company is a startup. There is no legacy business or bureaucracy in their organization. There’s a real mission in delivering more value through better prescribing decisions. Lastly, Carm states that RxRevu is a startup. They have taken venture money, but also have several health systems as major investors. This has allowed the company to have a much more intimate relationships with providers at the point of care. Carm believes it has allowed them to uncover things others have not. 

Why haven’t digital companies like Amazon or Yelp entered this space? Or have they and just failed? Carm says more than $10 billion dollars have been invested in digital healthcare over the past 10 years and we’re really not seeing any outcomes. He believes this is happening due to the wide-spread assumption that the consumer is always the answer. Carm suggests focusing dollars and efforts on improving physician decision making instead. 

To conclude the discussion, Gary asks Carm to explain what he would say to a payer CEO about price transparency. Carm stresses this is the number one thing you can do. Bringing transparency is one of the first and most effective things you can do to help physicians understand there are lower-cost options. It’s informed autonomy for the doctors. They still have the decision power, but you want those decisions to be informed by a high level of information and a narrow set of options.