Turquoise Health reposted this
What does it cost to have a baby in the United States? The answer has fundamentally changed as of today: July 1st, 2024. This question has always vexed me. I've tried unsuccessfully to prospectively price deliveries for others over the years with Price Is Right-like guesstimates of accuracy. Deliveries are expensive - anywhere from a couple hundred dollars, to a couple thousand, to over $10,000 depending on insurance and the complications (or lackthereof) of the birth. With 3.6 million babies born last year in the US, you might think we as a country should have this one figured out. We don't. About 67% of births in the US are normal vaginal deliveries. The remainder, generally, are C-Sections without major complications. Finally, there is a long tail of complex deliveries and NICU stays that require other clinical and insurance resources to kick in. Today, thanks to much needed updates in hospital price transparency regulations, the math for families welcoming babies gets a bit simpler. It's up to innovators to turn this new data into pre-visit, bedside, and post-visit experiences for patients that rival buying a flight on Kayak or booking a stay on Booking. com. Here are the main updates: ✔New data points emerge that make it easier to separate "no-nonsense pricing" from "complex math pricing." Patients, given the right tools, can opt for no-nonsense pricing experiences when they value peace of mind. ✔New fields make it easier to compare payer and plan types, simplifying the ability to match prices to insurance cards. ✔The new data format makes it leaps and bounds easier to enforce transparency compliance at a national level, leading to fewer gaps in data. Most importantly, sunlight continues to act as the best disinfectant. With the veil lifted on the math itself, hospitals and insurance companies can compete on pricing simplicity. What could it look like to offer an all inclusive delivery rate, regardless of professional fees, delivery method, or days in the hospital? What could it look like to inform a patient bedside that their stay is already included in a flat rate and they don't need to sweat every last charge? What could it look like to empower patients bedside to make basic cost-benefit decisions when they can save money with little to no risk on outcomes? How much could hospitals save if they didn't have to go after patient collections for bills sent weeks and months post-encounter? How would trust improve between patient and provider if the only mail received post-encounter was a congratulations card from the clinical staff? Before July 1st 2024, we could glimpse the potential for this type of patient experience but the math was still too fuzzy. Now, with higher resolution data available thanks to years of regulatory work and advocacy, it's time for Turquoise Health and others to step up for the 3.6M families that go through childbirth in the US every year.
Add to the equation the fact that “more than 4 out of 10 births are covered by Medicaid, and this coverage has no out-of-pocket costs for pregnancy-related services” and you have an even more complicated set of variables for which to solve. Source: https://www.healthinsurance.org/faqs/what-is-the-cost-of-having-a-baby-with-health-insurance/
Peter Borans
1w
Chris Severn good you are bringing this topic up and of course just a bit of "coopertition" here for the greater good. This can be done today with the data (all be it not easily) as demonstrated below. This view leverages NY data (at the state level) for a few plans for a vaginal birth coded from the ground up using MRF data. Allowed in this instance = Negotiated which does not take into account deductibles, co-pays, etc. To your point, better data would make this a whole lot easier for those who don't have the resources.
Cory Legere
3w
Thank you for the update on hospital price transparency regulations. As a parent who has experienced home births, I understand the complexities and frustrations of trying to anticipate medical costs. My family opted for home births with a midwife, paying out-of-pocket to avoid hidden fees and gain personalized support throughout the process. Is this new data also relevant for those considering home births? We found that hiring a midwife provided a clear, upfront cost, and I wonder if these changes will further support families exploring home birth options. With transparency and simplified pricing, the hope is that all families can make informed choices that best suit their needs, whether at home or in a hospital setting.
Matt Weeks
3w
I completely agree, Chris. But we’re all the way down at the base of that mountain at fundamental (and much more common) #transparentpricing issues for so many Americans. When you figure that millions of working-age people have traded a low premium for a high deductible, they are in essence self-funding the bulk (or all) of their annual healthcare spend. We get excited about this in this industry sector and we say: “here comes transparent pricing and now you’ll be able to compare costs across providers…” Well not so fast. We’re a ways away, even though directionally it is inevitable. Value based care is going to expose even more disparity and confusion in terms of coverage under Medicare…most specifically what is *not* fully covered. Okay back to the simplest procedures (way simpler than a childbirth).. how about an abdominal CT scan with contrast? I dare you or anyone on this thread to try to get a quick and practical price comparison and then get the payer to accept it as credit towards the deductible without spending 10 hours on the project. This is where we are today. Lots to do and many amazing people and companies working to make it easier. Keep up the great work at Turquoise Health! We need you! #goodwork
Chris, this is a great question. We are starting to see health systems really dive into bundling these type of procedures on MDsave (and Tendo Care Connect for Employers). For example, check out a vaginal delivery (~$7,817) and a c-section ($9,435) on our consumer site at a top baby delivery hospital in Nashville - Ascension Saint Thomas...where my kids were born :) . We are excited to see these types of procedures "shopified" on MDsave. Exciting times.
One other layer of transparency is missing. We need patients to understand that many of the interventions in obstetrics aren't always necessary. There is just as much harm in intervening as not intervening. Good, long-term, transparent data can help us figure out who needs what.
Steve Rowe
3w
Very excited to see you and the the broader Turquoise Health team build this out, primarily so I can stop being the medical financial planner for all my friends. Same applies for other complex medical procedures you all look at. For pregnancy in particular the real miss seems to be upstream at choosing the right insurance plan, though. At least in commercially-insured circles I run in, very few pregnancies are unplanned; most couples know they are going to try to start / add to a family in the next year(or a woman is already pregnant when open enrollment comes up). The math at this point is pretty easy: just choose the highest premium, plush plan your employer offers. Lock in a copay. If you know you'll have at least $10K plus in medical expenses in the next year, a deductible plan makes no sense. This is where the education is needed. Right?
Welcome news for families - and those planning and expecting! It's been a long time but I still remember having no clue what this would cost us until we got the bills
Ali Russo
3w
Very excited to see such granular and insightful information!
Full Stack OB/GYN. Healthcare Disruptor. Tech focused User Advisor & Tester; Wartime Consigliere. Let’s Build Something!
3wChris Severn how’s Turquoise doing on compiling data for outpatient care (the obstetrician), the anesthesiologist (or more broadly RAP services inpatient). Big and important elements for providing care estimates outside of hospital DRG payments. ps… thank you, sincerely, for getting me to actually laugh out loud. Please share where you dug up the “couple of hundred dollar” deliveries!! Tijuana?