Lauren Vela Discusses Surprise Medical Billing and Price Transparency

Congressional efforts to end surprise medical billing have a real possibility of succeeding, but recent discussions around transparency have a lot more challenges, said Lauren Vela, senior director of the Pacific Business Group on Health (PBGH).

Do you think the bill from Senators Lamar Alexander, R-Tennessee, and Patty Murray, D-Washington, can end surprise medical billing?
I do. I mean I do! I think we’re already seeing it. We’ve already seen changes. Elizabeth Mitchell, the chief executive officer of PBGH, testified, as well as others, and we already see changes as a result of that. I think that the American public has said, “Enough is enough. This is not ok.” Our Congress men and women are saying, “Enough is enough. We’re going to make changes.” And this is something they can really understand and sink their teeth into and fix. And I actually anticipate that there will be other good things that come out of the lower healthcare cost bill, but I think surprise billing will be one of those things.

Do you think greater price transparency will result in lower healthcare costs? Will patients actively seek out that information?
We think transparency in healthcare is very, very important. I don’t think it’s the holy grail. I think it’s very, very complicated, and I think often the transparency that’s being spoken of today is not meaningful transparency because it might not actually be transparency about prices that consumers actually pay. So, there’s a lot of caveats in all of that. But moving towards transparency is a good thing.

I also think that where we have had transparency, it hasn’t necessarily been used; so, consumerism hasn’t really worked when we’re depending on the consumer to do a lot of work. Especially if they’re doing work and getting inaccurate information. So, I think there’s a lot of potential and possibility in the space of transparency, it in and of itself is not the only solution but it’s a step in the right direction.

I think part of the problem with our system is that it’s so complicated and untransparent that it has allowed intermediaries and other stakeholders to continue and perpetuate a system where incentives are not aligned. So, having transparency on that will help break down some of those historical paradigms.

What needs to be done to make healthcare more transparent and shoppable?
It needs to be user friendly. Information needs to be user friendly… and you know we have steps to get there. So, the transparency that’s being spoken of today in the executive order and other places is not necessarily the end-all, but it’s a step in the right direction. Because what it really means to be is “very easily accessible at the time when a patient needs it, showing an episode of care, and showing what the patient’s portion of the payment will be.” So, adjusted so it’s showing contractual rates. I mean all of that is going to be really critical to have it be really meaningful to patients, and any transparency that we can do to get there is a good thing.
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