Price transparency in healthcare is essential for providing patients with clear, upfront costs of medical services, empowering them to make informed financial decisions.

In this episode of Straight Out of Health IT, Dr. Jonathan Kaplan, founder and CEO of BuildMyHealth, explains how their new platform DrWell addresses this challenge by offering real-time cash-pay price transparency, connecting patients directly with providers to ensure both affordability and continuity of care. Historically, healthcare pricing has become complex due to advancements in technology, third-party insurance involvement, and evolving payment models. Therefore, patients often face hidden costs, such as copays and deductibles, leading to unexpected financial burdens.

In this conversation, Dr. Kaplan highlights that cash-pay options can often be more cost-effective than relying on insurance, especially for non-emergency services like outpatient procedures and medications. Increased price transparency drives competition among providers, ultimately reducing costs for patients while encouraging them to explore cash-pay options. For providers, adopting transparent pricing models and embracing cash-pay services can ensure financial sustainability and independence, particularly as insurance reimbursements continue to decline.

Dr. Kaplan believes that moving forward, the healthcare system is expected to shift toward a market-driven model where insurance primarily covers catastrophic events, while patients pay out of pocket for more routine services. Consumers are advised to check prices ahead of time, explore cash-pay rates, and avoid defaulting to insurance when it isn’t cost-effective. Providers are encouraged to treat patients transparently, offering clear cost estimates and embracing models prioritizing affordability, trust, and improved care outcomes.

Tune in for an eye-opening conversation on how price transparency in healthcare can save you money, empower your choices, and transform the way you approach medical care!

Imagine a healthcare solution that not only motivates patients to take charge of their health but also tackles the toughest challenges faced by our most vulnerable communities.

In this episode of Straight Out of Health IT, Matthew Swanson, co-founder and CEO of Reciprocity Health, Incorporated, shares insights into how his company is transforming healthcare by combining behavioral health economics and digital tools. Founded in 2020, Reciprocity Health focuses on improving patient activation in Medicaid and Medicare, particularly among vulnerable populations. Their flagship platform, TheraPay, uses financial incentives integrated with digital tools to enhance patient adherence to medical programs. This innovative approach addresses systemic barriers to care, drawing on Swanson's prior experience in education and systemic reform.

Reciprocity Health’s managed service model was inspired by a CMS study highlighting the effectiveness of financial incentives in chronic care but also the challenges in implementation. The platform simplifies complex administrative processes and assigns rewards to each step of a patient's care journey, such as completing screenings or surveys. By partnering with trusted community organizations, Reciprocity extends its reach into underserved populations, fostering trust and deeper engagement. This model has empowered families to earn meaningful financial rewards while improving their healthcare adherence and outcomes.

The company operates as a for-profit enterprise, sustained through client-funded programs with ROI analyses that demonstrate the cost savings of preventive care. At HLTH 2024, Reciprocity Health sought partnerships with health systems, payers, and care providers to accelerate the adoption of value-based care initiatives. Matt emphasizes that Reciprocity acts as a "rising tide," benefiting all stakeholders by reducing costs, improving care delivery, and putting money in patients’ pockets. By aligning interests across the healthcare ecosystem, Reciprocity Health is driving meaningful and sustainable change.

Tune in for an inspiring conversation with Matthew Swanson to discover how his innovative approach to financial incentives and behavioral health is transforming lives and redefining patient engagement in Medicaid and Medicare!

Addressing the complex challenges within Medicaid and Medicare requires a holistic approach focused on data-driven solutions, workforce diversity, and an integrated system of care that prioritizes individual needs and promotes health equity.

In this episode, Ashley Gray, Vice President at Sirona Strategies, discusses the future of Medicaid, Medicare, and other government healthcare programs. She explores the sustainability of Medicaid, given rising healthcare costs and an aging population, emphasizing the need for increased support for home and community-based services.

Ashley talks about the complexities faced by dual eligibles and advocates for value-based payment models and managed care that are designed to provide more coordinated care. She explains the critical role of public health initiatives and interoperable health IT systems and the importance of having a diverse workforce that builds trust with the populations being served.

Finally, Ashley further emphasizes the need for data-driven policy changes, gathering more robust social determinants data to inform appropriate solutions, and highlights the urgent need to move beyond siloed programs.

Join us to learn how value-based payment models will help incentivize the delivery of quality care rather than quantity of care and to understand the future of government healthcare programs!