As Price Transparency Grows Inevitable, Healthcare Providers Need Better Tools and Processes To Close the Gap on Patient Trust
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As Price Transparency Grows
Inevitable, Healthcare Providers
Need Better Tools and Processes
To Close the Gap on Patient Trust
Transcript of a discussion on how healthcare providers can become more proactive in financial
and cost transparency from the patient perspective.
Listen to the podcast. Find it on iTunes. Download the transcript. Sponsor: HealthPay24.
Dana Gardner: Hi, this is Dana Gardner, Principal Analyst at Interarbor Solutions, and
you’re listening to BriefingsDirect.
Our next healthcare finance insights discussion explores ways that healthcare providers
can become more proactive in financial and cost transparency from the patient
By anticipating rather than reacting to mandates on healthcare economics and process
efficiencies, providers are becoming more competitive and building more trust and
satisfaction with their patients -- and caregivers.
To learn more about the benefits of a more proactive and
data-driven approach to healthcare cost estimation, we
are joined by expert Kate Pepoon, Manager of Revenue
Cycle Operations at Baystate Health in Springfield,
Mass. Welcome, Kate.
Pepoon: Thank you for having me.
Gardner: We are also here with Julie Gerdeman,
President of HealthPay24 in Mechanicsburg, Penn.
Good to have you back, Julie.
Gerdeman: Thanks, Dana.
Gardner: We are at the point with healthcare and
medical cost transparency that the finger, so to speak,
has been pulled out of the dike. We have had mandates
and regulations, but it's still a new endeavor. People are feeling their way through
providing cost transparency and the need for more accurate estimations about what
things will actually cost when you have a medical procedure.
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Kate, why does it remain difficult and complex to provide accurate medical cost
Education is healthy
Pepoon: It has to do with educating our patients. Patients don’t understand what a
chargemaster is, which, of course, is the technical term for the data we are now required
to post on our websites. For them to see a spreadsheet that lists 21,000 different codes
and costs can be overwhelming.
What Baystate Health does, as I’m sure most other hospitals in Massachusetts do, is
give patients an option to call us if they have any questions. You’re right, this is in its
infancy. We are just getting our feet wet. Patients may not even know what questions to
ask. So we have to try and educate as much as possible.
Gardner: Julie, it seems like the intention is good, the idea of getting more information in
peoples' hands so they can make rational decisions, particularly about something as
important as healthcare. The intent sounds great, but the implementation and the details
are not quite there yet.
Given that providers need to become more proactive, look at the different parts of
transparency, and make it user-friendly, where are we in terms of this capability?
Gerdeman: We are still in the infancy. We had a race to
the deadline, to the Centers for Medicare and Medicaid
Services (CMS) [part of the U.S. Department of Health
and Human Services] deadline of Jan. 1, 2019. That’s
when all the providers rushed to at least meet the bare
minimum of compliance. A lot of what we have seen is
just the publishing of the chargemaster with some
But where there is competition, we have seen it taken a
bit further. Where I live in Pennsylvania, for example, I
could drive to a number of different healthcare providers.
Because of that competition, we are seeing providers
that don't just provide context, they are leveraging the
chargemaster and price transparency as competitive
Gardner: Perhaps we should make clear that there are many areas where you don’t
really have a choice and there isn’t much competition. There is one major facility that
handles most medical procedures, and that’s where you go.
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But that's changing. There are places where it’s more of a marketplace, but that's not
necessarily the case at Baystate Health. Tell us why for your patients, they don't
necessarily do a lot of shopping around yet.
Clearing up charge confusion
Pepoon: They don't. That question you just asked Julie, it's kind of the opposite for us
because we have multiple hospitals. When we posted our chargemaster, we also posted
it for our other three hospitals, not just for the main one, which is Baystate Medical
Center (BMC). And that can create confusion for our patients as well.
We are not yet at the drive to be competitive with other area hospitals because BMC is
the only level-1 trauma center in its geographical area. But when we had patients ask
why costs are so different at our other hospitals, which are just 40 miles away, we had to
step up and educate our staff. And that was largely guiding patients as to the difference
between a chargemaster price and what they are actually going to pay. And that is more
an estimate of charges from their particular insurance.
We have not yet had a lot of questions from patients, but we anticipate it will definitely
increase. We are ready to answer the questions and guide our patients.
Gardner: The chargemaster is just a starting point, and not necessarily an accurate one
from the perspective of an outsider looking in.
But it began the process to more accurate price transparency. And even while there is
initially a regulatory impetus, one of the biggest drivers is gaining trust, loyalty, and a
better customer experience, a sense of confidence about the healthcare payments
Julie, what does it take to get past this point of eroding trust due to complexity? How do
we reverse that erosion and build a better process so people to feel comfortable about
how they pay for their healthcare?
Learn How to Meet Patient Demands
for Convenient Payment Options
for Healthcare Services
Gerdeman: There is an opportunity for providers to create a trusted, unique, and
personalized experience, even with this transparency regulation. In any experience
when you are procuring goods and services, there is a need for information. People want
to get information and do research. This has become an expectation now with
consumerization -- a superior consumer experience.
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And what Kate described for her staff, that's one way of providing a great experience.
You train the staff. You have them readily available to answer questions to the highest
level of detail. That's necessary and expected by patients.
There is also a larger opportunity for providers,
even just from a marketing perspective. We are
starting to see healthcare providers define their
brand uniquely and differently. And patients will
start to look for that brand experience. Healthcare
is so personal, and it should be part of a
Gardner: Kate, I think it's fair to say that things are going to get even more challenging.
Increasingly, insurance companies are implementing more co-pays, more and different
deductibles, and offering healthcare plans that are more complex overall.
What would you like to see happen in terms of the technologies and solutions that come
to the market to help make this process better for you and your patients?
Accounting for transparency
Pepoon: Dana, transparency is going to be the future. It's only going to get more …
This infancy stage of the government attempting to help educate consumers -- I think it
was a great idea. The problem is that that did not come with a disclaimer. Now, each
hospital is required to provide that disclaimer to help guide patients. The intent was
fantastic, but there are so many different ways to look at the information provided. If you
look at it face-value, it can be quite shocking.
I heard a great anecdote recently, that a patient can go online and look at the
chargemaster and see that aspirin is going to cost them $100 at a hospital. Obviously,
you are taken aback. But that’s not the actual cost to a patient.
There needs to be much more robust education regarding what patients are looking at.
Technology companies can help bring hospitals to the next level and assist with the
education piece. Patients have to understand that there is a whole other layer, which is
their actual insurance.
In Massachusetts we are pretty lucky because 12 years ago, then-Governor Mitt
Romney [led a drive to bring health insurance to almost everyone]. Because of that, it’s
reduced the amount of self-pay patients to the lowest level in the entire United States.
Only around two to three percent of our patients don’t have insurance.
Some of the benefits that other states see from the published chargemaster list is better
engaging with patients and to have conversations. Patients can say, “Well, I don’t have
Healthcare is so personal,
and it should be part of a
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insurance and I would like to shop around. Thank you to Hospital A, because Hospital A
is $2,000 for the procedure and Hospital B is only $1,500.”
But Massachusetts, as part of its healthcare laws, further dedicates itself to educating
patients about their benefits. MassHealth, the Medicaid program of Massachusetts,
requires hospitals to have certified financial counselors.
Those counselors are there to help with patient benefits and answer questions like, “Is
this going to cost me $20,000?” No, because if you sign up for benefits or based on the
benefits you have, it's not going to cost you that much. That chargemaster is more of a
definition of what is charged to insurance companies.
The fear is that this is not so easily explained to patients. Patients don’t always even get
to the point where they ask questions. If they think that something is going to cost
$20,000, they may just move on.
Gardner: The sticker shock is something you have to work with them on and bring them
back to reality by looking at the particulars of their insurance as well as their location,
treatment requirements, and the specific medical issues. That's a lot of data, a lot of
information to process.
Not only are the patients shopping for healthcare services, they will also be shopping for
their next insurance policy. The more information, transparency, and understanding they
have about their health payments, the better shopper they become the next time they
pick an insurance company and plan. These are all choices. This is all data-driven. This
is all information-dependent.
So Julie, why is it so hard in the medical setting for that data to become actionable? We
know in other businesses that it's there. We know that we can even use machine
learning (ML) and artificial intelligence (AI) to predict the weather, for example. And the
way we predict the weather is we look at what happened the last 500 times a storm
came up the East Coast as an example that sets a pattern.
Where do we go next? How can the same technologies we use to predict the weather be
brought to the medical data processing problem?
Gerdeman: Kate said it well that transparency is
here, and transparency is the future. But, honestly,
transparency is table stakes at this point.
CMS has already indicated that they expect to expand the pricing transparency ruling to
require even more. This was just the first step. They know that more has to be done to
address complexity for patients as consumers.
Technology is going to play a critical role in all of this, because when you reference
things like predicting the weather and other aspects of our lives, they all leverage
Transparency is here, and
transparency is the future.
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technology. They look back in order to look forward. The same is true for and will be
used in healthcare. It’s already starting to.
So [patient support] teams like Kate’s use estimation tools to provide the most accurate
as possible costs to patients in advance of services and procedures. HealthPay24 has
been involved as part of our mission, from pre-service to post-service, in that patient
But it is in arming providers and their staffs with that [predictive] technology that is most
important for making a difference in the future. There will always be complexities in
healthcare. There will always be things happening during procedures that physicians
and surgeons can’t anticipate, and that’s where there will be modifications made later.
But given what we know of the costs around the 5,000 knee replacements some
healthcare provider might already have done, I think we can begin to provide forward-
looking data to patients so that they can make informed decisions like they never have
before by comparing all of that.
See the New Best Practice
Of Driving Patient Loyalty
Gardner: We know from other industries that bringing knowledge and usability works to
combat complexity. And one of the places that can be most powerful is for a helpdesk.
Those people are on the other end of a telephone or a chatbot from consumers --
whether you are in consumer electronics or information technology.
It seems to me that those people at Baystate Health, mandated by the Commonwealth
of Massachusetts, who help patients are your helpdesk. So what tools would you like to
see optimally in the hands of those people who are explaining away this complexity for
How to ask before you pay
Pepoon: That’s a great question. Step one, I would love to see some type of education,
perhaps a video from some hospitals if they partnered together, that helps patients
understand what it is they are about to look at when they look at a chargemaster and the
dollar amounts associated with certain procedures.
That’s going to set the stage for questions to come back through to the staff that you
mentioned, the helpdesk people, who are there ready and willing to respond to patients.
But there is another problem with that. The problem is that these are moving targets.
People like black-and-white. People like, “This is definitely what I’m going to pay,” before
they get a procedure done.
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We have heard of the comparison to buying a car. This is very similar to educating
yourself in advance, of looking for a specific model you may like for a car, of going to
different dealers, looking it up online, seeing what you’re going to pay and then
negotiating that before you buy the car.
That’s the piece that’s missing from this healthcare process. You can’t yet negotiate on
it. But in the future – with the whole transparency thing, you never know. But it’s that
moving target that’s going to make this hard to swallow for a lot of patients because,
obviously, this is not like buying a car. It’s your life, it’s your health.
The future is going to have more price transparency. And the future is also going to bring
higher costs to patients regardless of who they are and what plan they have. Plans 10
years ago didn’t have deductibles. The plans we had 10 years ago that had a $5 co-pay,
and now those plans have a $60 co-pay and a $5,000 deductible.
That’s the direction our healthcare climate is moving to. We are only going to see more
cost burdens on patients. As people realize they are going to need to pay out more
money for their own healthcare services, it’s going to bring a greater sense of concern.
So, when they do call and talk to that
helpdesk, it’s really important for all of us in
all of our hospitals to make sure that we are
answering patients properly. It was an
amazing idea to have this new
transparency, but we need to explain what it
means. We need to be able to reach out
personally to patients and explain what it is
they are about to look at. That’s our future.
Gerdeman: I would just like to add that at HealthPay24 we work with healthcare
providers all across the country. There are areas that have already had to do this. They
have had to be proactive and jump into a competitive landscape with personalized
We are starting to see educational videos in places like Pennsylvania using the human
touch, and the approach of, “Yes, we recognize that you’re a consumer, and we
recognize that you have a choice.” They have even gone to the extent of creating online
price-checkers and charge-checkers to give people flexibility from their homes of
conveniently clicking a box from a chargemaster to determine what procedure or service
they are to be receiving. They can furthermore check those charges across multiple
hospitals that are competing and that are making those calculators available to
Gardner: I’m sensing a building urgency around this need for transparency from large
organizations like Baystate Health. And they are large, with service providers in both
Western Massachusetts as well as the “Knowledge Corridor” of Massachusetts and
When [consumers] do call and
talk to that helpdesk, it’s really
important for all of us in all of our
hospitals to make sure that we
are answering patients properly.
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Connecticut. They have four hospitals, 80 medical practices, 25 reference laboratories,
12,000 employees, and 1,600 physicians.
They have a sense of urgency but aren’t yet fully aware of what is available and how to
solve this problem. It’s a big opportunity. I think we can all agree it’s time now to be
proactive and recognize what’s required to make transparency happen and be accurate.
What do you recommend, Kate, for organizations to be more proactive, to get out in front
of this issue? How can vendors in the marketplace such as Julie and HealthPay24 help?
Use IT to explain healthcare costs
Pepoon: There needs to be a better level of education at the place where patients go
to look at what medical charge prices are. That forms a disclaimer, in a way, of, “Listen,
this is what you are about to look at. It’s a little bit like jargon, and that’s okay. You are
going to feel that way because this is raw data coming from a hospital, and a lot of
people have to go to school for very long time to read and understand what it is that they
are looking at.”
And I think if there has to be a way that we can have patients focused and able to call
and ask questions. That’s going to help.
For the technology side going forward, I am very interested to see what it’s going to look
like in about a year. I want to see the feedback from other hospitals and providers in
Massachusetts as to how this has gone. Today, quite frankly, when I was doing research
for us at Baystate I reached out to find out what are the questions patients are asking.
Patients are not really calling that much to talk about this subject yet. I don’t know if
that’s a good thing or a bad thing. I think that that’s a sentiment most hospitals in
Massachusetts are feeling right now.
I don’t think there is one hospital system
that’s ahead of the curve or running
toward the goal of plastering all of this
data out there. I don’t think everybody
knows what to do with it yet. IT
companies and partners that we have --
our technical partners like HealthPay24
– can help take jargon and put it into
some version that is easily digestible.
That is going to be future. It ties back to the question of: Is transparency going to be the
wave of the future? And that’s absolutely, “Yes.” But it’s all about who can read the
language? If me and Julie are the only two people in a room who can read the language,
we are letting our patients down.
I don’t think everybody knows what to
do with [all of this data] yet. IT
companies and partners that we have
– our technical partners like
HealthPay24 – can help take jargon
and put it into some version that is
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Gardner: Well, engineering complexity out is one of the things the technology does very
well. Software has been instrumental in that for the past 15 or 20 years.
Julie, as we end our discussion, for organizations like Baystate Health that want to be
more proactive, to be able to answer those patient phone calls in the best way, what do
you recommend? What can healthcare provider organizations start doing to be in front of
this issue when it comes to accurate and transparent healthcare cost information?
View a Webinar
on How Accurate Financial Data
Helps Providers Make Informed Decisions
Gerdeman: There is a huge opportunity to look at technology available today, as well
as emerging technology and where it’s headed. If history proves anything, Dana, to your
point, it’s that technology can provide new levels of clarity and reduce complexity. You
can digitize processes that were completely manual and where everything needed to be
done on the phone, via fax, and on paper.
In healthcare, there’s a big opportunity to embrace technology to become more
proactive. We talk about being proactive, and it really means to stop reacting and take a
strategic approach, just like in IT architectures of the past. When you take that strategic
approach you can look at processes and workflows and see what can be completely
digitized and automated in new ways. I think that’s a huge opportunity.
I also don’t want to lose sight of the humane
aspect because this is healthcare and we are
all human, and so it’s personal. But again,
technology can help personalize experiences.
People may not be calling because they want
access online via their phone, or they want
everything to be mobile, simple, beautiful, and
digital because that’s what we increasingly
experience in all of our lives.
Providers have a great opportunity to leverage technology to make things even more
personal and humane and to differentiate themselves as brands, in Massachusetts and
all across the country as they become leading brands in healthcare.
Gardner: I’m afraid we’ll have to leave it there. You’ve been listening to a sponsored
BriefingsDirect healthcare finance insights discussion on how healthcare providers can
become more proactive in modernizing financial and costs transparency -- from the
patient perspective. And we’ve learned how anticipating rather than reacting to
mandates on healthcare economics and process efficiencies builds more trust and
satisfaction from patients as well as their caregivers.
People … want access online via
their phone, or they want
everything to be mobile, simple,
beautiful, and digital because
that’s what we increasingly
experience in all of our lives.
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So please join me in thanking our guests, Kate Pepoon, Manager of Revenue Cycle
Operations at Baystate Health. Thank you so much, Kate.
Pepoon: Thank you, it was great.
Gardner: And we have been here with Julie Gerdeman, President of HealthPay24.
Thank you so much, Julie.
Gerdeman: Thanks for the opportunity, Dana.
Gardner: And a big thank you as well to our audience for joining this HealthPay24-
sponsored healthcare thought leadership discussion.
I’m Dana Gardner, Principal Analyst at Interarbor Solutions, your host and moderator.
Thanks again for listening, and do come back next time.
Listen to the podcast. Find it on iTunes. Download the transcript. Sponsor: HealthPay24.
Transcript of a discussion on how healthcare providers can become more proactive in financial
and cost transparency from the patient perspective. Copyright Interarbor Solutions, LLC, 2005-
2019. All rights reserved.
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