Commentary: State treasurer wants hospitals to cough up the data

 In October 2018

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Commentary

“When anyone is afraid of lifting a curtain, the question to ask is, ‘Why?’ The only logical answer is they don’t want you to see what is behind the curtain.”

Sounds like a comment from a skeptical magazine editor. But that’s how John Jenkins, head of Cone Health’s telephone- and internet-based health programs, answers my question on why hospitals and health insurers don’t provide more specifics on their pricing.

I asked because N.C. State Treasurer Dale Folwell is making health care transparency a top priority, and Greensboro-based Cone is a national leader in using innovation to trim costs. Like many N.C. systems, Cone waived its fee for virtual health care for Hurricane Florence victims. Unlike many peers, Cone cited the usual price, $49, in a press release.

Knowing how much a hip replacement, MRI or other procedure costs is important for Folwell because he chairs the State Health Plan for employees and retirees, where medical costs are increasing at a 6% to 8% annual clip. The self-insured plan spends $2.7 billion annually on care for its 727,000 members. To promote competition that may drive down costs, he suggests providers should share pricing as clearly as car dealers.

Attacking the issue is important for N.C. business owners, whose angst over rising health-insurance costs probably prompts more late-night worrying than any other issue.

Folwell, who likes to use his bully pulpit more than other state officials, pressed UNC Health Care in July to provide more details on its $250 million in annual charges for state employees’ care.

The system replied with a heavily redacted contract that didn’t provide enough detail to satisfy Folwell. So the treasurer responded with a satirical press release full of its own blacked-out words.

Cost transparency is a national issue, so it’s unfair to cast N.C. hospitals and physicians as the bad guys. Disclosing such information could put UNC at a competitive disadvantage with its rivals. Folwell should focus more on employee wellness instead of criticizing hospitals, wrote Steve Lawler, president of the N.C. Healthcare Association, in an op-ed.

UNC is “moving as rapidly in this direction as we can” in collaborating with others in the health care industry to ensure “high-quality care and the lowest cost,” a spokesman says. Patients often receive estimated costs before procedures or treatments, though he notes that much available data can be hard for people to understand.

Blue Cross Blue Shield of North Carolina believes publicizing “trade secrets” helps no one, a spokesman says. The insurer administers the state plan. Gov. Roy Cooper’s administration isn’t publicly backing Folwell. State Budget Director Charles Perusse, a plan board member, declined interview requests.

Still, something has to give. Fortunately, my employer covers much of my insurance cost, but the out-of-pocket premium for my wife and me just increased 28%. Our state has promised more than $25 billion of expected medical costs for state employee health care, for which there is no reserve.

“Transparency helps everyone,” Cone’s Jenkins says. “It holds those delivering services accountable. It lets consumers understand if costs are rising or not. It allows businesses to understand what they are getting for their insurance dollars.”

Folwell says he will keep pushing. “We have the responsibility of not just paying the bills but understanding what we are supposed to pay.”

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