WRKO>Audio & Video on Demand>>Marshall Allen (ProPublica, Employers & Health Care)

Marshall Allen (ProPublica, Employers & Health Care)

Oct 10, 2018|

Transcript - Not for consumer use. Robot overlords only. Will not be accurate.

The financial exchange. All ordering and and also now in West Palm Beach, Florida check out our web site had financial exchange showed Doug come and find the station closest to you. This is the financial exchange radio network. And joining us now on the line is Marshall Allen from port probe public. You talk about how employers are trying to battle back against high health care costs Marshall thanks for joining us today. Marshall before we get into what employers are doing do we have any data on just how bad the problem of health care costs have gotten for employers these days. Well here and believe you about it through your employer you probably have noted how year after year or cost keeps going up your benefits keep going getting worse. And down you're out of pocket spending keep getting higher. And there really is affecting. People's take home pay you know about a 151 million American. Get their benefits through their employer and literally the costs keep going up every year now for decades. So can you describe some of the things that you outlined in your article specifically some of the cases. That this this one in Montana. What companies are trying to do in order to mitigate those costs. Well I did a story about. The month and I can only benefit plan and that as a planned for 30008. And weighs in Montana but it's definitely a larger plan. And the story about a woman named to Maryland bar is an accountant and very savvy woman took over the plan. And decided to push back against the high health care Cobb. Basically when she took over that planet when he fourteen it was going Perot I mean it was projected two leaders. About fifty million dollars in the coming years and be bankrupt and so they had to make changes. And what she'd be ahead is she decided to push back against the high credit hospitals. And that her own prices and basically make the expensive hospitals take less money. How does that work. Well it actually worked really well I mean it was a tough battle but it started way it I think the prices of the hospitals and that is actually easier said than done. She had to basically work where it another vendor it helper compare the prices that she was paying. What Medicare is and then watching it is that. Hospitals were charging anywhere from two times the Medicare rate to five times the Medicare rate and the plan was paying those high prices. And so she she that the pride and basically went to the hospital instead. Take it or leave it were the ones paying the bills and if you want to PR agent you need to take less money. Answer was able to persuade all hospitals to get on board with the new Chrysler arrangement. Assure us a little bit about it on I I know that Medicare is often use is kind of a benchmark bit you know if you look at is there any way to look at kind of the real costs. Hospitals are facing as opposed to use seeing that benchmark number has. You always hear about how. You know because of one set of populations costs are passed on to other populations you know within the system and so I'm just always countries of the real costs are. Well you know that's a great question and the problem is that the hospitals have never had to justify their actual cops. And so they're standard way of Billings has been to bill at extremely high amounts and then give discounts based on insurance company contracts. And so if you're insured you're supposed to get this special raid. From the hospital but the problem there is that he is great there really that. Based on the negotiating leverage their different insurance companies and different hospitals in different markets. And so the actual crisis the pace and end up paying insured patients and a paying insurance plans than that paying. Are actually associated directly with the cost of providing the care itself. Marshall in a lot of cases is there any incentive for an insurance plan to go out and searched it in push people towards. The cheapest alternatives has. I don't think a lot of consumers what where when they're going out let's say that someone has. You know it of medical condition that they need treated maybe it's a heart condition and it could be a kidney condition whatever it is. Individuals are looking for the best care for themselves but. As you outlined in this article the same procedure could cost you three times Mort a different hospital in not necessarily getting three times the level of care. What incentives are there for insurers or patients shop around at this point. Well patients a much greater and the we've ever because more of these culture being passed on I mean you know we have rising deductibles now OE crust you agree. Year after year we're seeing the first two dollar on all the care and it it's common for people have deductibles of 2000 to 5000 dollar you. And it your deductible about tie that in all that money is coming out of your pocket before the insurance even expand. And so more and more patients are realizing wit and I need to find out what I'm paying for. And so you know people what are you in this story and other experts that are you would say that. You should always now demand that they explained what they're charging you or they need to give you an itemized in boys and they need to actually justify those costs. And the more patient can be that the more hopefully. Hospitals start providing the price that that car. Marshall what are the other pieces that you outlined in this story here wasn't just targeting. Hospital cause but also prescription drug costs what would you find out of this case in Montana. Well so the prescription drug costs have also been skyrocketing and a lot about it. I mean that increasing cost is coming from the middle meant provider of pharmacy benefit the cult pharmacy benefit managers. And they're the ones you know one company's insurance company might manage the medical side of your benefits. The pharmacy benefits manager will manage the drug the drug side here at. And this middleman has been operating with a lot of different schemes like in Montana. They look there's something called the spread and the threat as just where the pharmacy benefit managers. A big LB employer paying the bills that. And they cost you know fifty dollars to fill prescriptions when actually it cost 25 dollars scripture and so they just. Albeit Wear out if he and then they pocket the extra 25 dollars and the system saying that. Is illegal because it's written into the fine print of their contracts. But it's it's not something that in many employers are aware when they sign up for their help benefit and that they're very common theme. That happens every day in the industry. And what in the month and that way and Marilyn Bartlett started digging into her pharmacy benefit contract. She's that they were losing a lot of money has spread. And so she booted Earl pharmacy benefit manager and chief one that would operate without this Brad. And that was it that if that plan millions of dollars. So is that kind of a reference to some of the side deals and kickbacks and lucrative clauses that you found and they you alluded to you in your article. Yeah that's exactly right in the project and doing this year's really looking at the way we paper health care and digging and all these ideals and I think patients don't realize that rising cost of care isn't just because the carrots bell has gotten more expensive. It hasn't gotten more complicated to statement here placement. You know this year than it was five years ago. Port at Europe and extra in fact a lot of that technology is exactly the same. There's a whole network there layer upon layer of metal. That are pulling money out of us that and finding new ways to keep taking more and more money on employers and from workers and that's why we keep paying more and more money. Thurgood Marshall we've got to run but thanks for joining us they were really appreciated thanks for putting this together it's great work thanks you degrade our and that is Marshall Allen from pro Republican talking about employers in the cost of health care and certainly. You know just about anyone in. You know you could pick any time period you want the last five years ten years twenty years it's not just that health care's got more expensive but that. While more that cost being pushed towards individuals deductibles continue to rise. Just because the overall cost of insurance is. It's it's not right not to be completely honest and you know bits we were in it in its so hard for us to measure. Those cost changed because some will say OJ the cost of a you know your plan went up by 5% this year. What went up by 5% but your deductible increased by 20% so how much more you actually paying really tough to measure those changes. Absolutely and you know as our population. Demographics shift for having aging population are only gonna see more pressure on the system we've got to figure out. How to start managing those costs that are so we can make sure we can provide quality care and I think that that. We focus so much on the cost side that I happened think about the actual delivery and not that great quality that are providing absolutely.