The PBM Transparency Space

In Indiana, we have hospital systems, private equity, and insurance companies that essentially own most of our physician practices. We would support many others, including banning physician non-competes. And other idea is, and I'll limit my comments to three ideas, is really on the PBM transparency space. There's no transparency anywhere in that supply chain.

Transcript

chevron_right

Play full episode

chevron_right

Transcript

Episode notes

If you go to the Sage Transparency dashboard Web site, you get a really graphical representation of the prices that any given hospital actually needs to charge so that they break even. You can see precisely which hospitals are operating on thin margins and which ones are not.

You might be thinking, “Okay, so ... what’s the big deal about this? Why is the Sage Transparency information so meaningful? Aren’t hospitals (most of them) providing their financial statements already?”

Well, let’s discuss. First of all, we have the main hospital lobbying organization coming out with press releases such as this one saying (here’s some quotes): “Hospitals have incurred serious losses …” “The vast majority of America’s hospitals [are] in serious financial jeopardy …”

Combine quotes like these (and there are many) with some of the funny stuff going on in some (not all) hospital financial reporting—like counting investment losses from their venture funds, not counting endowments or their big trusts in the math, paying C-suites way more than the average doctor or worker, or all of the varied things that get counted or overcounted as charity care or community benefit—yeah, these hospital balance sheets are too often as much of a PR campaign as the PR campaigns. When you dig into them, you find some very wealthy organizations dressing up in Tiny Tim Cratchit pants and leaning on a crutch … at least whenever the cameras are rolling.

So, where are patients in all of this? Chris Deacon linked to a Qualtrics study recently. It seems that in 2020, 48% of people deferred care as a result of the pandemic. In 2022, 43% deferred care because of cost—48% from the pandemic, 43% deferred due to cost this past year … wow!

There are patients saying, “Hey, I have this giant thing growing on my arm. Is it melanoma? I don’t know, but I do know if I go to the doctor, I’ll be $600 in the hole … so I’ll wait.”

It doesn’t matter how many medical advancements are made when almost half of the patients are making decisions like this, including patients with so-called “good” insurance.

Look, no one would or is arguing that hospitals aren’t vital. They are essential. Hospitals can be amazing places where lives get saved. Amazing doctors and clinicians work in hospitals. But putting everything I just said together, let me summarize a textbook hospital chain one-two punch.

The halo effect many hospitals enjoy is massive, and those administrators who choose to can take advantage of that halo for financial gain. When hospitals’ administrators cannot manage to curtail their own spending and then demand that their communities foot the bills, then the good that a hospital can do starts to go bad.

If you are a legislator, you might want to be paying attention to all of this. And when I say might be wanting to pay attention, I mean pretty much you want to be paying attention to all of this. With all of the data that is now available to especially more sophisticated employers, some companies are not building offices or plants in areas which are known to have healthcare prices that are multiples over what they should be. That might be in your legislative district or state.

Healthcare prices can be the largest cost for employers after payroll. Starbucks famously spends more on healthcare than they do on coffee beans. Nearly 8 of 10 employers considered healthcare costs a significant threat to affordability.

So, too high hospital prices are a community problem at the chamber of commerce as well as at the family and the patient level.

After you listen to this show, go back and listen to the one last week with Mike Thompson (EP389) if you haven’t already. It adds some context that you might want to have. Also stay tuned for a show coming up where we talk about just all of the anticompetitive stuff that some of these hospital system administrators have decided to subject their communities to.

In this healthcare podcast, I have two titans of employer coalition building on the episode. Gloria Sachdev from the Employers’ Forum of Indiana, who was instrumental in standing up the Sage Transparency dashboard that we talked about last week and we’ll discuss a little bit more this week. Gloria is a pharmacist, which I did not know. She also sits on the board for the National Alliance of Healthcare Purchasers Coalition and Hoosiers for Affordable Healthcare.

Also on the show is the one and only Chris Skisak, who leads the Houston Business Coalition on Health. He also speaks for the state of Texas through his role with Texas Employers for Affordable Healthcare.

You can learn more at txeahc.org and houstonbch.org.

You can also check out the Employers’ Forum of Indiana Web site as well as sagetransparency.com.

Gloria Sachdev, PharmD, serves as president, CEO, and board chair of the Employers’ Forum of Indiana. She also serves as adjunct associate professor at Purdue College of Pharmacy. Forum initiatives focus on hospital price and quality transparency, value-based health benefit and payment strategies, and health policy. She serves as a member of the Board of Governors for the National Alliance of Healthcare Purchaser Coalitions and as board vice chair for Hoosiers for Affordable Healthcare.

Dr. Sachdev received her bachelor of science and doctor of pharmacy degrees from the University of Oklahoma and completed a primary residency at the VA in Madison, Wisconsin. Thereafter, she practiced in primary care physician offices managing patients with chronic diseases for 12 years, followed by consulting in the space of incorporating clinical pharmacists into team-based care for 6 years. She retired from Purdue College of Pharmacy after 15 years but still teaches a few classes for fun.

Chris Skisak, PhD, is the executive director of the Houston Business Coalition on Health, a multi-stakeholder but employer-centric 501(c)(3) focused on improving the cost, quality, and consumer experience in healthcare delivery. He is also the executive director of Texas Employers for Affordable Healthcare, a legislative advocacy organization focused on creating a competitive healthcare delivery ecosystem. Dr. Skisak also serves on the boards of directors of the National Alliance of Healthcare Purchasing Coalitions and Texas Business Group on Health. He serves on the leadership councils for Houston Cities Changing Diabetes, Houston Health Equity Collaborative, and Center for Houston’s Future. He had previously worked 25 years with Houston Fortune 50 energy companies in a variety of population health management positions. He is originally from Chicago and attended the University of Illinois. He received his master of science degree and PhD from the University of Texas School of Public Health.

06:04 How could the healthcare market correct itself?

08:27 EP334 with Sunita Desai, PhD.

09:38 What strategies are needed to make changes in the healthcare market?

10:13 What can be done with respect to market forces?

12:33 What needs to happen in regard to healthcare legislation?

13:03 Gloria’s ideas for legislation.

15:44 Why is it important to allow physicians to be independent again?

17:41 EP373 with Cora Opsahl.

18:21 Chris’s thoughts on legislation.

22:51 Why is it important that employers become present in the legislative process?

26:48 What has been immensely helpful to better understand hospital financials?

31:08 EP385 with Dan Mendelson.