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Hello, everyone. This is Jacob Emerson with the

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Becker's Payer Issues podcast.

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Thrilled today to be joined by Emily Porter,

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who is the vice president of external affairs

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at Sidecar Health. Emily, thank you so much

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for taking the time to be with me

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on the podcast today.

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Sure. Thank you for having me.

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So before we dive into everything we wanna

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talk with you about, Emily, and, a big

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policy change going on in Washington, can you

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talk to us a little bit about your

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career background and what it is that you're

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doing today at Sidecar Health?

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Sure. So I,

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I got my my career start at a

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think tank in Washington DC.

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I won't say how many decades ago, but

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many years ago.

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And then I worked on Capitol Hill for

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about a decade. So I spent most

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of that decade working for,

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former congressman John Boehner

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and worked for him in the majority leader's

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office and in his his role in the

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leadership generally

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as minority leader, and then I I ended

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my role with him in the speaker's office.

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So I left The Hill, about twelve years

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ago, and then I went to work at

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a small boutique lobbying

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firm in Downtown

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DC where many of our clients were all

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in the health care sector, so anything from

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insurance to hospitals to medical device.

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And then one of those clients that we

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had was, Sidecar Health.

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And I was very intrigued at the outset

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about what Sitecore Health has to offer. It

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was truly the only thing I had seen

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in my career that

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actually creates

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a market incentive for consumers to be engaged

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in probably the most meaningful way,

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that they've ever been engaged in health care.

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And

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that was that was really exciting for me,

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having been on Capitol Hill during

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the Medicare part d program consideration,

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during the

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Affordable Care Act consideration and multiple other pieces

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of of big legislation that I'm sure we're

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all familiar with. But this was really something

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that

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I thought was the most interesting in terms

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of not requiring

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any sort of government

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subsidy or tax credit or some of the

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more,

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some of the more obvious

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carrots and sticks that we see in other

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legislation.

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Fantastic. So you've got a long career in

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in politics and in DC, Emily, and that's

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why we wanted to come to you to

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ask specifically about

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president Trump signing a new executive order in

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February aimed at cracking down on price transparency

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requirements for hospitals and insurers. And that, of

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course, follows his original executive order on health

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care price transparency back in 2019.

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So I think the natural question there is,

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what is the difference? What changes

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do insurers need to know about this new

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EO?

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What's what does it do differently?

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So as you as you articulated, Jacob, in

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the previous executive order, health plans and hospitals

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obviously were both swept up in that, but

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health plans were instructed to

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post their negotiated rates with providers and their

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out of network

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payments to providers and then the actual prices

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that they paid for prescription drugs.

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And then they had to maintain an online

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tool in order to permit

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customers to access that particular pricing information.

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This executive order,

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which we're very supportive of, obviously, at Sidecar

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Health because we we are a major medical

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product based on price transparency

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and giving consumer information. But this executive order

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requires

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the,

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requires the plans and hospitals

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to put up actual pricing. So

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previously, I think we've seen a lot of

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estimates.

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And so now there is a requirement that

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actual prices

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must be disclosed,

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and it requires that the department determine what

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kinds of enforcement policies

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they want to implement

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to ensure that the providers are compliant.

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So it will mean that not only will

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health care entities have to determine how they

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disclose a price in

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Toledo, Ohio

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or

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Jacksonville, Florida, but but that becomes, I think,

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a very meaningful and and different way that

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for the consumer

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and the plans to figure out how to

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share that pricing so that it's constructive and

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and useful.

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Absolutely. So more concrete information,

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actual prices, not estimates being required from insurers

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across the country.

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And so you mentioned insurers have been required

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to disclose a lot of this pricing information

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starting in 2022.

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It staggered from there over the years.

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So what's compliance been like, from your perspective,

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Emily, up until now across the industry?

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Are are insurers actually following these rules?

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So first, I'll say that, just

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go on with your question here in a

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second. But first, I I will say I

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do think

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that insurers are supportive of transparency. I think

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the crux of the issue has always been

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applicability

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and making sure that it's applicable in a

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uniform way and having the kind of data

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that

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that is displayed in a consistent

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consumer friendly format. I think that's where it

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can be a real game changer for the

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consumer, and we see this every day in

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what we do at Sycor Health. I think

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I think under these particular

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executive orders so first of all, the hospitals

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were required to disclose that information prior to

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insurers

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being required to in 2022.

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So I think you've seen some some delay,

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in enforcement

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really because I think in part, it was

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tied up in courts for a while.

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And but I think we all share the

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goals, obviously, of giving consumers the information to

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make good choices, but there has been a

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bit of a lag in the Biden administration.

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But I think there's always going to be

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different priorities

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depending on who is in the White House

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and what the directives

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are from the senior folks at those

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departments. And I think

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in this particular instance,

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you know, there's maybe not been

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some of the processing of pricing data

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that has been a priority

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when you think about

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all of the other issues that both hospitals

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and insurers are trying

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to work on every single day that really

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has nothing to do with price transparency, but

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is trying to is trying to work on

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just other issues related to Medicare or Medicaid

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and and different payments. So but I I

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do think,

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overall,

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hospitals and insurers, like, we very much value

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our hospital partners. And when it comes to

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giving consumers

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pricing information,

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we share those goals,

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but we really just wanna make the experience

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for the consumer smooth. And I think that's

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where

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sharing actual data

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is really gonna be a game changer in

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terms of, let's call this,

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executive order two point o, in terms of

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how this second executive order really sort of

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forces

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that positive direction, I think, forward for the

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next generation of of pricing in health care.

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Absolutely. Absolutely. And you mentioned some of the

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challenges and delays we've seen in enforcement. And

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and just so our audience is aware for

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context, we know that 18 hospitals have been

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fined for for noncompliance with these rules since

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they first came out. No insurers have been

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by CMS. So so that's where things currently

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stand.

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But but, Emily, you mentioned that this all

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comes back down to making things easier in

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health care for the consumer. So

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where do things stand in terms of, third

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party companies and consumers' ability

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to to use this data, and to know

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what their health care costs will be before

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they they go to the doctor's office?

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Sure. So I think it's always good for

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consumers and or for hospitals and insurers to

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provide this data, as you say, in a

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more actionable way. I think that helps move

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the ball forward and creates a more educated

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health care population. And this really is

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the next generation of evaluating what those next

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steps are. And in any sort of

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public policy,

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any sort of public policy development, there's always

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going to be room for progress.

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And I think this exercise

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from the Trump administration

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is

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a smart exercise in terms of

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how to make that public policy more effective

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for the consumer. I think we wanna make

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sure providers obviously,

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are providing that information

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in a way that is digestible. Consumers are

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savvy, and that's something that I've learned a

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lot about at SacroHealth, but they like having

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additional information to the extent that they're able

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and being able to share that information in

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a way that is

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is digestible.

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And like I said earlier, in a uniform

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manner,

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in a way that they're buying anything else

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throughout their daily lives, that's a real that's

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a real,

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step forward. And we wanna make sure, obviously,

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providers

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that they don't need to go through prior

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authorization and they don't have to pay,

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or that we don't have to pay with

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a middleman. There should be immediate payment, and

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there is a privilege for the customer to

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be able to choose what they want. And

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sharing

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pricing

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is part of the process or a step

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in giving them that privilege to be able

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to go wherever they wanna go. I do

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think sharing this kind of data also opens

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the door for other innovation

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in the healthcare sector, which we think innovation

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is is always a good thing.

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And it will probably result in more opportunities

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for,

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you know, think about the the Google Healths

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and the Amazons of the world to create

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other innovative models that help give consumers the

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tools they need to be

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smarter and better consumers. And whether it's through

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artificial intelligence

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or

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website

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tools or just other,

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more intuitive ways to get information,

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I think that that that is always gonna

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be a positive step forward.

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Absolutely. Yeah. It is very exciting to think

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about what could come from this new executive

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order within the private sector. Yeah. But, Emily,

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before we go, I think would you educate

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our audience on on the Sidecar Health model

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and how you all are using the price

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transparency

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data today?

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Sure thing. So Sidecar Health is a large

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group major medical insurance product.

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We give consumers

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pricing information so that they know what every

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single thing in the health care system

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can cost, and we give them that data

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on our website. And so they're able to

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compare,

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and we do this for all 170,000

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things you can do in the healthcare system,

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as well as for any FDA approved drug.

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So the consumers can compare

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and determine where they want to go because

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we don't have a lot of the more

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onerous

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or frustrating things that that more traditional insurers

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have. We don't have a network. We don't

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have prior authorization.

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We don't have set therapy or formularies. And

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again, we just don't have some of the

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more burdensome

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things. So we give the cons we give

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the consumer,

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a budget that they need to be able

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to shop, and then it's up to them.

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If they wanna go someplace that is over

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the budget that we're giving them, that's totally

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fine. That's their prerogative. But if they want

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to go someplace that that costs less, we're

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gonna let them keep part of that savings.

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And so it really is a game changer

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when you think about the consumer having more

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skin in the game

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and and being able to consume health care,

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like I said earlier, in a meaningful way,

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in a way they consume everything else in

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their lives. But we're really excited about what

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we've seen from consumers so far. Like I

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said, consumers are really smart and they like

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having the data. And we're seeing about 90%

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of our claims come back where consumers

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are getting their services either at the budget

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that we give them or slightly above with

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maybe what we consider like a co pay

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amount, like $15 or $20

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but they're choosing also to go to sites

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of care that are less costly and

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are finding a lot of success also at

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the pharmacy and saving a lot of money

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and being able

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to, you know, kind of almost compete a

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little bit sometimes with their coworkers. I know

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we certainly do that inside the company in

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terms of where we found good prices. And

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it really is an eye opening and exciting

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experience for both just us, but also the

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consumer. And we love hearing love hearing all

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the feedback.

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Well, appreciate that overview, Emily, and it'll be

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fascinating to watch as a sidecar continues to

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disrupt across the industry.

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Before we go, we've got a lot of

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health plan leaders listening in. Any final thoughts

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or final bits of advice you wanna offer

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them in terms of, this this new executive

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order and what that means for price transparency

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moving forward?

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Well, I think there's I do think sometimes

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there's an impression that perhaps

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there's, I think, a lot of opposition

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to price transparency depending on what industry. And

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and I think I'd like to maybe just

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share. I don't think that's true. I think

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there is a lot of support for transparency.

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I think that

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there is a lot of

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there are a lot of federal and state

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programs that both hospitals and insurers are trying

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to comply with. And so there's a little

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bit of a a push pull between

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between where some of the attention can be

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focused. But I do think that

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insurers and, like I said earlier, our hospital

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partners,

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they're supportive of giving the consumers

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more information

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and more,

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more information that'll make them better consumers because

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we want the consumer to have a smooth

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experience. And so I think we do all

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truly have,

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you know, shared goals in that area. This

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probably I'm maybe giving you more of a

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a kumbaya answer than you wanted, but but

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I do think sometimes in the field, there's

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a little bit of a, the sense that

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there's consternation. And I think in this case,

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there isn't. I think because the prices have

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been somewhat hidden for quite some time that

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it's

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a different administrative role to make some of

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that pricing more public, but we're really excited

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to have allies in that effort. And we're

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very grateful

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to have all the providers that that we

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have that that do take Sitecore Health customers

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because we wanna make that experience really

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enlightening and smooth for the consumer.

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Fantastic. Well, Emily, thank you so much for

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taking the time to sit down with us

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and for sharing your insights with our listeners.

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We really appreciate it. Thank you so much.

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And if you'd like to listen to more

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podcasts from Becker's Healthcare, you can visit beckershospitalreview.com.