Hello, everyone. This is Jacob Emerson with the
Becker's Payer Issues podcast.
Thrilled today to be joined by Emily Porter,
who is the vice president of external affairs
at Sidecar Health. Emily, thank you so much
for taking the time to be with me
on the podcast today.
Sure. Thank you for having me.
So before we dive into everything we wanna
talk with you about, Emily, and, a big
policy change going on in Washington, can you
talk to us a little bit about your
career background and what it is that you're
doing today at Sidecar Health?
Sure. So I,
I got my my career start at a
think tank in Washington DC.
I won't say how many decades ago, but
many years ago.
And then I worked on Capitol Hill for
about a decade. So I spent most
of that decade working for,
former congressman John Boehner
and worked for him in the majority leader's
office and in his his role in the
leadership generally
as minority leader, and then I I ended
my role with him in the speaker's office.
So I left The Hill, about twelve years
ago, and then I went to work at
a small boutique lobbying
firm in Downtown
DC where many of our clients were all
in the health care sector, so anything from
insurance to hospitals to medical device.
And then one of those clients that we
had was, Sidecar Health.
And I was very intrigued at the outset
about what Sitecore Health has to offer. It
was truly the only thing I had seen
in my career that
actually creates
a market incentive for consumers to be engaged
in probably the most meaningful way,
that they've ever been engaged in health care.
And
that was that was really exciting for me,
having been on Capitol Hill during
the Medicare part d program consideration,
during the
Affordable Care Act consideration and multiple other pieces
of of big legislation that I'm sure we're
all familiar with. But this was really something
that
I thought was the most interesting in terms
of not requiring
any sort of government
subsidy or tax credit or some of the
more,
some of the more obvious
carrots and sticks that we see in other
legislation.
Fantastic. So you've got a long career in
in politics and in DC, Emily, and that's
why we wanted to come to you to
ask specifically about
president Trump signing a new executive order in
February aimed at cracking down on price transparency
requirements for hospitals and insurers. And that, of
course, follows his original executive order on health
care price transparency back in 2019.
So I think the natural question there is,
what is the difference? What changes
do insurers need to know about this new
EO?
What's what does it do differently?
So as you as you articulated, Jacob, in
the previous executive order, health plans and hospitals
obviously were both swept up in that, but
health plans were instructed to
post their negotiated rates with providers and their
out of network
payments to providers and then the actual prices
that they paid for prescription drugs.
And then they had to maintain an online
tool in order to permit
customers to access that particular pricing information.
This executive order,
which we're very supportive of, obviously, at Sidecar
Health because we we are a major medical
product based on price transparency
and giving consumer information. But this executive order
requires
the,
requires the plans and hospitals
to put up actual pricing. So
previously, I think we've seen a lot of
estimates.
And so now there is a requirement that
actual prices
must be disclosed,
and it requires that the department determine what
kinds of enforcement policies
they want to implement
to ensure that the providers are compliant.
So it will mean that not only will
health care entities have to determine how they
disclose a price in
Toledo, Ohio
or
Jacksonville, Florida, but but that becomes, I think,
a very meaningful and and different way that
for the consumer
and the plans to figure out how to
share that pricing so that it's constructive and
and useful.
Absolutely. So more concrete information,
actual prices, not estimates being required from insurers
across the country.
And so you mentioned insurers have been required
to disclose a lot of this pricing information
starting in 2022.
It staggered from there over the years.
So what's compliance been like, from your perspective,
Emily, up until now across the industry?
Are are insurers actually following these rules?
So first, I'll say that, just
go on with your question here in a
second. But first, I I will say I
do think
that insurers are supportive of transparency. I think
the crux of the issue has always been
applicability
and making sure that it's applicable in a
uniform way and having the kind of data
that
that is displayed in a consistent
consumer friendly format. I think that's where it
can be a real game changer for the
consumer, and we see this every day in
what we do at Sycor Health. I think
I think under these particular
executive orders so first of all, the hospitals
were required to disclose that information prior to
insurers
being required to in 2022.
So I think you've seen some some delay,
in enforcement
really because I think in part, it was
tied up in courts for a while.
And but I think we all share the
goals, obviously, of giving consumers the information to
make good choices, but there has been a
bit of a lag in the Biden administration.
But I think there's always going to be
different priorities
depending on who is in the White House
and what the directives
are from the senior folks at those
departments. And I think
in this particular instance,
you know, there's maybe not been
some of the processing of pricing data
that has been a priority
when you think about
all of the other issues that both hospitals
and insurers are trying
to work on every single day that really
has nothing to do with price transparency, but
is trying to is trying to work on
just other issues related to Medicare or Medicaid
and and different payments. So but I I
do think,
overall,
hospitals and insurers, like, we very much value
our hospital partners. And when it comes to
giving consumers
pricing information,
we share those goals,
but we really just wanna make the experience
for the consumer smooth. And I think that's
where
sharing actual data
is really gonna be a game changer in
terms of, let's call this,
executive order two point o, in terms of
how this second executive order really sort of
forces
that positive direction, I think, forward for the
next generation of of pricing in health care.
Absolutely. Absolutely. And you mentioned some of the
challenges and delays we've seen in enforcement. And
and just so our audience is aware for
context, we know that 18 hospitals have been
fined for for noncompliance with these rules since
they first came out. No insurers have been
by CMS. So so that's where things currently
stand.
But but, Emily, you mentioned that this all
comes back down to making things easier in
health care for the consumer. So
where do things stand in terms of, third
party companies and consumers' ability
to to use this data, and to know
what their health care costs will be before
they they go to the doctor's office?
Sure. So I think it's always good for
consumers and or for hospitals and insurers to
provide this data, as you say, in a
more actionable way. I think that helps move
the ball forward and creates a more educated
health care population. And this really is
the next generation of evaluating what those next
steps are. And in any sort of
public policy,
any sort of public policy development, there's always
going to be room for progress.
And I think this exercise
from the Trump administration
is
a smart exercise in terms of
how to make that public policy more effective
for the consumer. I think we wanna make
sure providers obviously,
are providing that information
in a way that is digestible. Consumers are
savvy, and that's something that I've learned a
lot about at SacroHealth, but they like having
additional information to the extent that they're able
and being able to share that information in
a way that is
is digestible.
And like I said earlier, in a uniform
manner,
in a way that they're buying anything else
throughout their daily lives, that's a real that's
a real,
step forward. And we wanna make sure, obviously,
providers
that they don't need to go through prior
authorization and they don't have to pay,
or that we don't have to pay with
a middleman. There should be immediate payment, and
there is a privilege for the customer to
be able to choose what they want. And
sharing
pricing
is part of the process or a step
in giving them that privilege to be able
to go wherever they wanna go. I do
think sharing this kind of data also opens
the door for other innovation
in the healthcare sector, which we think innovation
is is always a good thing.
And it will probably result in more opportunities
for,
you know, think about the the Google Healths
and the Amazons of the world to create
other innovative models that help give consumers the
tools they need to be
smarter and better consumers. And whether it's through
artificial intelligence
or
website
tools or just other,
more intuitive ways to get information,
I think that that that is always gonna
be a positive step forward.
Absolutely. Yeah. It is very exciting to think
about what could come from this new executive
order within the private sector. Yeah. But, Emily,
before we go, I think would you educate
our audience on on the Sidecar Health model
and how you all are using the price
transparency
data today?
Sure thing. So Sidecar Health is a large
group major medical insurance product.
We give consumers
pricing information so that they know what every
single thing in the health care system
can cost, and we give them that data
on our website. And so they're able to
compare,
and we do this for all 170,000
things you can do in the healthcare system,
as well as for any FDA approved drug.
So the consumers can compare
and determine where they want to go because
we don't have a lot of the more
onerous
or frustrating things that that more traditional insurers
have. We don't have a network. We don't
have prior authorization.
We don't have set therapy or formularies. And
again, we just don't have some of the
more burdensome
things. So we give the cons we give
the consumer,
a budget that they need to be able
to shop, and then it's up to them.
If they wanna go someplace that is over
the budget that we're giving them, that's totally
fine. That's their prerogative. But if they want
to go someplace that that costs less, we're
gonna let them keep part of that savings.
And so it really is a game changer
when you think about the consumer having more
skin in the game
and and being able to consume health care,
like I said earlier, in a meaningful way,
in a way they consume everything else in
their lives. But we're really excited about what
we've seen from consumers so far. Like I
said, consumers are really smart and they like
having the data. And we're seeing about 90%
of our claims come back where consumers
are getting their services either at the budget
that we give them or slightly above with
maybe what we consider like a co pay
amount, like $15 or $20
but they're choosing also to go to sites
of care that are less costly and
are finding a lot of success also at
the pharmacy and saving a lot of money
and being able
to, you know, kind of almost compete a
little bit sometimes with their coworkers. I know
we certainly do that inside the company in
terms of where we found good prices. And
it really is an eye opening and exciting
experience for both just us, but also the
consumer. And we love hearing love hearing all
the feedback.
Well, appreciate that overview, Emily, and it'll be
fascinating to watch as a sidecar continues to
disrupt across the industry.
Before we go, we've got a lot of
health plan leaders listening in. Any final thoughts
or final bits of advice you wanna offer
them in terms of, this this new executive
order and what that means for price transparency
moving forward?
Well, I think there's I do think sometimes
there's an impression that perhaps
there's, I think, a lot of opposition
to price transparency depending on what industry. And
and I think I'd like to maybe just
share. I don't think that's true. I think
there is a lot of support for transparency.
I think that
there is a lot of
there are a lot of federal and state
programs that both hospitals and insurers are trying
to comply with. And so there's a little
bit of a a push pull between
between where some of the attention can be
focused. But I do think that
insurers and, like I said earlier, our hospital
partners,
they're supportive of giving the consumers
more information
and more,
more information that'll make them better consumers because
we want the consumer to have a smooth
experience. And so I think we do all
truly have,
you know, shared goals in that area. This
probably I'm maybe giving you more of a
a kumbaya answer than you wanted, but but
I do think sometimes in the field, there's
a little bit of a, the sense that
there's consternation. And I think in this case,
there isn't. I think because the prices have
been somewhat hidden for quite some time that
it's
a different administrative role to make some of
that pricing more public, but we're really excited
to have allies in that effort. And we're
very grateful
to have all the providers that that we
have that that do take Sitecore Health customers
because we wanna make that experience really
enlightening and smooth for the consumer.
Fantastic. Well, Emily, thank you so much for
taking the time to sit down with us
and for sharing your insights with our listeners.
We really appreciate it. Thank you so much.
And if you'd like to listen to more
podcasts from Becker's Healthcare, you can visit beckershospitalreview.com.