This Week Health

Chad Brisendine on Price Transparency and Consumer Engagement

You can do price transparency for compliance or for the consumer. Chad Brisendine from St. Luke's University Health Network joins us to discuss an approach that benefits the consumer. Hope you enjoy.

Transcript

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 Welcome to this Week in Health, it influence where we discussed the influence of technology on health with people who are making it happen. My name is Bill Russell, recovering healthcare, c I o. And creator of this Week in Health it a set of podcasts and videos dedicated to developing the next generation of health IT leaders.

This podcast is brought to you by Health Lyrics. You Need a Health IT Executive coach. Let's talk visit health lyrics.com to schedule your free consultation today we're joined by Chad Undine, C I O of St. Luke University Health Network, and one of my favorite young CIOs. Morning Chad, and welcome to the.

Good morning, bill. Thanks again for having me. I'm gonna keep you in that class of younger CIOs since every time I go to one of these Chime events. Now, it seems like people are in their late fifties, early sixties as CIOs, and you're, you're not in that category yet, I don't think. Nope. Just at my 40th birthday.

Well, congratulations. Well, I, I'm excited for our conversation. So today, uh, you have a hard stop. Uh, so we're gonna, we're just gonna jump right into it. Uh, our two main topics today are price transparency is something which I think St. Luke's has done a really good job on and, uh, on consumer engagement. So, uh, let's, let's just jump into, uh, price transparency.

'cause I heard you give a talk at the, uh, at thes.

So every, every health system's handling price transparency, a little a just a little different. Uh, why don't you give us some background on what your team did and how they approached it. Yeah, so a little, uh, bit of background. I think, uh, first I would say, um, our CEO's vision has always been to have low, low cost, high quality, easy access.

Access from a, you know, consumer access standpoint as far as services, services, availability, location, quality. Obviously that means a lot of things, but we have more, uh, very defined quality, uh, programing mechanisms, and then obviously cost. And one of the things we've always felt is, is that we do have a cost advantage, um, in our market.

And and beyond from what we consider cost. And I know that's a hairy subject whenever you talk about it in healthcare. Um, but for me it's all about the consumer's cost and the consumer's out of pocket. And that's the vantage and viewpoint, um, that I really take and that we really take. So, We were doing that work back in 20 13, 20 14.

We were doing a lot of research around what transparency and what cost transparency or price transparency was, and we really weren't able to find a lot people, had some organizations and where I came at before, um, also had their prices online. Which was basically their me, uh, you know, their, their, their fee schedule right on there is kind of what happened with the government regulation.

They said, put it on there, everybody put it on there, and nobody can understand it. So, um, in about 2015, we decided to build out a prototype of, uh, what we call price checker. And basically we put online prices available. But what's unique about that price transparency is, is that it's a bundled . Price it's meant to be for people that have high, have high deductible plans and have um, you know, a cash, cash price.

Uh, and what included in that is a is a bundling of services and it's a cash price and you don't get a bill and it also counts towards your insurance. So if you, you know, have a $5,000 out of pocket and the service costs you 4,000, then you still have a thousand left to meet your deductible. So I'll pause there 'cause there's a lot to it.

Um, you know, that's, that's what it's meant for us is about being able to provide certain consumers and segment to consumers a, a fully bundled price. Yeah. And, and I, I'm gonna go back to that, but it, it really is true that what, what we've seen is sort of a compliance approach to this as opposed to a consumer approach to it.

And the compliance approach is, all right, let's go to the charge master. Let's print these things out. Let's put it into a spreadsheet. Let's go ahead and put it out on the website. And then when you download those things, you take a look at 'em. You can't figure anything out. I mean, you've looked at a chargemaster, I've looked at a chargemaster.

It's really hard to navigate. Um, your consumer approach is much more. Um, it's, it's mobile. Uh, it's a, you have a mobile platform that they're able to go in there. They're able to see their price before, um, Before they're even able to get in there, and actually in some cases, because it's bundled and whatnot, you, you'll offer, if, if I understood what you were saying before, pretty correctly, you're actually offering a discount for, um, for paying upfront for some of those fees.

That's, that's correct. So actually we have two versions of it now. Um, we've partnered with a co-development company and have included some additional price or, or billing transparency tools within that as well. But basically we can, you can do an estimation now. So if you have, for example, you can go in there and look at your blue price and you can look at what we call the price checker or price lock price, which basically gives you the discounted price that we have.

So you can go with either or. Based on your insurance type. So that's, um, available now as well. And that's really, I mean, it makes sense to really target the, um, the high deductible plans. 'cause you know, people with low deductible plans aren't really consumers as much of healthcare, but, but those people that are price sensitive, uh, these kinds of tools make a lot of sense.

And, and, and that's, are, are you thinking of moving, making it more broad than that? Or are you gonna continue to focus in on that market? Uh, so our market has been primarily focused on, you know, high, high deductible plans, I'd say, 'cause they're the most ones that call to action. We have all the other transparency tools, like I said, the estimate, outof pocket estimate or all that stuff coupled into all this, because it's for the folks that have commercial insurance.

So the way we look at it's if you have a secondary commercial insurance, we have a set of products and capabilities to make that transparent for you. And then for the high deductible plans, we have that as well. And where I think we're unique and different is in the high deductible plan. I think a lot of people have put price estimation for commercial insurance folks out there on their web or mobile or whatever they've done.

Um, but where we're unique is this bundled high deductible. So for example, it includes your anesthesia costs. Or cost for your surgical procedure and your pre and post, you know, 90 day those physician visits that you have. So what we've done uniquely is partnered with our physicians in the community and said, here's the rate we're gonna take on all these things for it.

St. Luke's will take. The full amount from the consumer and then through our kind of B two B transactions, we'll pay the physicians, do the collections and all that stuff, but the patient at the end never gets a bill. So we've kind of taken that, you know, kind of all the transactional issues that people have with in a high deductible plan of being able to, because the problem is, is if you come to us and say, Hey, I wanna get a knee surgery.

You say, what's the price of that? Well, I can tell you how much the OR time costs. Well, no, that's not what we want. We want to be able to fly from, you know, LA to New York all in one trip and I don't want to have to go, uh, this person for my luggage. This person from my airplane ticket, this person for, uh, the food that's delivered on me.

I want it all in a bundled thing. So we've created a B two B relationship with our physicians, uh, and, and the, the B two C relationship is the consumer to St. Luke's. Yeah. So talk about the project. So there, there obviously is a, uh, there's a technology component to it. Talk, talk a little bit about that, then talk about the, the business side of it.

'cause there, there obviously was a lot to bring that network together, get the pricing. There's an awful lot of work to do there as well. This work is, was obviously the business, the business side of that, which I give, uh, our c o o and our um, . Our, uh, uh, project directors a lot of credit for doing a lot of the legwork on how we're gonna actually make this into like a business business model.

Uh, and I think the unique thing that they were able to do is, well, a, they did a lot of consumer research, so just calling out there and asking people what do people really want and what do they mean and what would they check on and how would they do things? So some voice of the customer part, right? Not, not as sexy as maybe marketing would do, but, but low scale that, um, actually our project director had, um,

Their family members and talked to all their family members and then they had their family members and then we checked other hospitals and called and everything. So pretty good. I think idea of what consumers really wanted and needed out of this was the first approach. Um, Finding out what they needed was a bundled price.

Um, so being able to develop that bundle price, it was literally working with certain procedures. So we started with a very simpler procedures to start out with. Now I think we have a couple hundred out there, but I think we started out with like 10, um, C P T codes that were out there, and then we began, and then certain physicians that we only worked with to start out and then we begin modeling it.

We also created a contact center. Specifically for this. So being able to set up a contact center, being able to check to see how many customers are getting us, so all the kind of components of what it would take to run a true, you know, customer contact center with, with being able to handle contract management, uh, and being able to handle, you know, the consumers asking questions and how to handle all that.

So I'd say that was a lot of heavy lifting of trying to get physicians on board with taking a certain rate for these patients. 'cause this isn't like 40% of your commercial business is going away with these rates. It's a, it's a, at least in our market today, it's a percentage of our business that we're willing to have a negotiated discount for.

And it was getting the physicians, I think, onboard with that conceptually. So I think that's really where a lot of the heavy lifting. Um, so that's the business ops side. Yeah. So what, what about the technology side? So you, you like to partner. Uh, did you do something off the shelf and then partner with that company in terms of customizing it for you guys?

Or did you build something out? We, uh, originally, um, the, the real quick prototype was just literally the webpage and as it got traction and we got more and more views, we determined, you know, we could either build this thing in fully scale out front and back end. Or we could really partner with somebody.

And we were already doing a lot of work on, um, transparency with the estimation, uh, bill pay, et cetera, with a, uh, Vendor partner. Uh, and we decided to co-develop with them. So they took the product, you know, built it within their platform. And now I think we're on version three of that release, uh, that's out there.

So they have that product in the market generally available as of probably about six or nine months ago. Um, that's awesome. So, so, so transitioning a little bit, 'cause we're gonna transition into consumer engagement. So how did you, how did you make the community aware of the program? I mean, was it billboards and ads and the, the traditional things?

I mean, how did you, how did you get adoption? I think, uh, there's a number of different ways. One, it was, um, there's a business coalition that meets here. 'cause a lot of this is . You know, us informing the business leaders. 'cause it's a lot of this is like right, certain businesses have decided to go with the high deductible for their employees.

And so it was a lot of the local business, um, bureaus and stuff like that, that our team did education and communication on. Um, it would literally patient stories. So we got, we've gotten the news several times because people heard about these stories. So a lot of word of mouth, um, obviously digital. We didn't do any billboards or anything like that, but a lot of digital marketing, you know, Facebook, LinkedIn, et cetera, with patient stories, we've had a lot of really great.

Patient stories of people coming from other, more, you know, our market and you've been here, um, your family's from here. So, you know, our market's kind of, kind of nestled north of, uh, Philly about an hour. And we're to the west of, uh, New York. About an hour and a half. We actually got patients from the both of those demographics to come to us because no one could really find.

Uh, this thing. So a lot of those stories were, we had travelers that literally came to us just 'cause they couldn't get a price anywhere needed to know what the total price was gonna be for a procedure and ended up, you know, paying cash, cash for our business. So a lot of that and, you know, digital marketing around that.

Yeah. So, uh, the last time you were on the show, uh, which was a pretty, uh, pretty listen to, uh, podcast, you talked about the development of, uh, uh, consumer engagement tool, uh, built, built on top of the Epic APIs, uh, with a really small development team and an external partner. Um, I think that was about, it was closer to a year ago.

We had that conversation. Can you give us an update on that? I mean, you had just rolled out a, a handful of, of applications on top of it. Here we're a year later. What, you know, where, where, where are you at? Uh, I looked the other day. We're at 143,000 unique logins for the month. And, um, on average seven times that someone's revisiting.

um, we're continuing. So when you, what, what are you offering that people keep, uh, are, are logging in and keep coming back? I mean, I think a lot of it is, is core, uh, what's inside the, um, epic system. You know, a lot of the high transactions are what's inside the medical record that people touch most of the time.

Right? I mean, you're, you're a new patient a few times. Few times, but once you're a new patient and you're in the system, you're constantly, you know, going to all your different tests. So what we're trying to do right now is look to optimize those different journeys within that piece. But right now we're continuing to try to expand our scheduling, our scheduling capability, uh, that we have in there.

Um, we are, um, in, in the next release, we're continuing to bridge. We, uh, had, um, a white label, uh, uh, video visit platform in there. And we're continuing to bring capabilities from that white label into our, uh, mobile web experience. So that's continuing to enhance that. We just hit our 4,000. Um, Consumer video visit.

We've had more than that in total, but 4,000 unique, uh, video visits. We just. This week inside of there. So, um, I would say that the highest transaction is gonna be results and stuff like that, just because you have so many of them that are pumping out, that people are looking at. Um, but what we're, what we're trying to optimize to is, you know, registration, scheduling and trying to ease all the pain of the high transaction areas.

Um, and that's where, that's our next set of releases is . Focusing on Reg and Sketch and how do we continue to optimize that? Our last feature that we rolled out that you feel like is really cool, um, is the not feeling well component. I don't know if we talked about that or had that deployed at that point.

Um, but that is basically low acuity triage, uh, is the best way to look in that. So when I'm on my mobile app or web or whatever, I can look and see. And it, uh, does it by time of day. It does it by what services are available at what time, and it also does it by what, um, what's available now. So on my app, I can see three, three care settings, uh, which we're trying to position them to.

One would be, you know, what appointments as a new patient or an existing patient or available for my primary care or my favorite physician. 'cause I can collect my favorite physician on my app within the next 24 48 hours. Which urgent cares 'cause we have a lot of convenient, urgent cares really close to you.

Uh, and it's all done back by location, proximity, what urgent Caress are available for you and you can clock into those ahead of time or skip the wait is what we call it. Uh, and then also the video visits. So we tee up different things for you based on the time of day, based on the location, et cetera. So it's kind of hypersensitive to I'm not feeling well and how do I get care now?

Uh, but it gives me multiple options for that care now. So we're gonna continue to advance that capability. Uh, it's still new. We're probably two months into the release of that, so we have more optimization. But the whole thought is get you, get you in, give you multiple options for that based on your preference as a consumer.

Yeah. So you're, so you're baking on top of the E Epic a p i, uh, your largest competitor in your market is, is on Epic as well. I mean, what, what advantage does this give you? It, it sounds like you're layering an awful lot of technologies on top of this to really take the, the friction out of the environment and I improve the consumer experience.

Um, what, what benefits are do you think you're getting at this point? Um, well, I think that there's, you know, kind of, there's maybe three worlds to view this then if you want to, there's the view of I'm gonna build all my consumer stuff, um, all on my own. You know what I mean? And everything's gonna be custom built and it's gonna be a hundred percent that way.

And if you know you're a c I O, you do that to have, you know, high, high competitive advantage, high differentiation, advantage, right? Um, so that you can build anything you want for your consumer. Then there's the middle of the ground, that's where I call us, where you leverage all the capabilities that you can from a third party without building them, and then you build what you need to, to give you competitive differentiation and advantage.

That's the model I think we've landed on. And then you have the model of your epic only. So, you know, there's choice, I guess in the matter of, of what architectures people want to pick. My view of the world is we get to leverage all the best capabilities of Epic. But where Epic and, and I love Epic, I mean they, they're a tremendous development company.

They, they pump out a lot of amazing stuff, but they don't have everything right. And they're never gonna have everything. And so how do we fill the gaps in, um, A lot of the capabilities I just mentioned to you are not things that we have in Epic, but I'm leveraging a lot of what we have behind Epic to push that to you as a consumer.

So where I can, a button's gonna be from Epic, from the backend, but a button may be from another third party vendor that we leverage in the ecosystem. So I know that's a lot of words. Um, no, that's, no, that's, I mean, I love how you frame that up, to be honest with you. I mean, it's, 'cause I have seen the fully custom shops, I've seen the people building on top of APIs.

And then I've seen the people just roll out, Hey, here's, here's MyChart. And away we go and, oh, and, and you run into this. I mean, you'll develop something and then Epic will put it on the roadmap and you'll have it in two years. Um, and, and that's just, that's part of the challenge of building on top of it is, you know, sometimes you're gonna, you're gonna, you're gonna develop some stuff today to go to the market that's gonna be replaced in two years.

But that's just the nature of the business. That is the nature of the business. I think we, we do it on the internal world a lot because we . We'll buy a third party Epic's not ready. We'll buy a third party app internally. Epic's not ready. You know, they, they don't have the capability. Um, there's many spots where they still don't have the capability.

We have a third party where we buy a third party. As soon as we can move it into Epic, 'cause it makes sense and it meets all the requirements, we move it into Epic and there's no difference on that, on the consumer. The only difference on our consumer is the front UX UI that you'll always see will always be ours.

Yeah. That's interesting. So what's the biggest surprise? So you're, you're, you know, over a year into it, year and a half, two years into developing on top, what's the negative and, and positive that you've experienced? I don't think there's a lot of lessons learned on all this. I think the, um, the understanding, the true journeys of these consumers from end to end, like you think, you know what end to end is until you start going down and then you look at end to end's different, um, And I would just say, you know, it's the journey mapping.

It's the customer, it's the hard work, you know, it's all the different components. Figuring out what should we really do next. Um, the prioritization of that. Um, and then the technical architecture. I think it's very complex. Um, I think, um, there's certain vendors, as I mentioned, my m r vendor does a great job at it, to be honest.

They're one of the best ones to provide an s d K and a p i and all that, even though everybody knocks 'em for that. They have been the best out of all of our partners from that. Perspective, even though you would think you would get something better outta Silicon Valley related to an S T K or an a p I, but everyone who wants to do, you know, the easy way out on this, they want to go HTML five and they want to push out a mobile, um, I mean a web, uh, to mobile rendered, which is, they call it, you know, interactive.

I call it slow. Um, you know, so I think, you know, there's all different ways to deliver these things. Um, and at the end I think it's just all about. What, what do you want for your consumers? And my perspective is, is we want the, um, best experience possible. Um, I wouldn't say I have that today. I would say our, our long-term goal is to have the best consumer experience possible.

And I don't consider it a small project. I consider it a journey, you know, something we're building over. You know, Chad, I, I, I wanna thank you for the, the time you gave me. I know you, you, you know, came from a meeting. I know you're going to a meeting, so I wanna honor your time here. And I just appreciate this, uh, this quick visit.

Hopefully we can touch base a little later in the year when the, uh, schedule slows down a little bit. Thanks a lot, bill. Sure. This show's a week, or this show is a production of this week in Health It. For more great content, check out the website and this week in health it.com or the YouTube channel at this week, health it com slash video.

Thanks for listening. That's all for now.

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