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Collectively, the two root issues driving health care’s cost crisis - the appropriateness of care and pricing failures - would become increasingly vivid.

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Conversely, predatory billing practices are rare in the few health care sectors that have already adopted real price transparency, including cosmetic surgery, in vitro fertilization, and LASIK surgery. … Asking how many patients will shop for care using price information is not the right question because proxy shoppers - self-insured employers, health plans, and some patients who pay out of pocket - will use real price information to drive the market for everyone. … Sixty percent of medical care is shoppable, representing a large opportunity for competition to reward centers with high quality and fair prices. … The issue is not how many people will look at prices. It’s whether we as a country will empower proxy shoppers to drive value in healthcare.

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The metrics must zero in on what it means for a patient’s quality of life and potential disability. The criteria should focus on significant harm or waste by extreme outliers rather than small variations in practice. The metric also must be measurable and designed so it can’t be tainted by bias or gaming. And finally, a sound metric should be highly actionable for the physician. … We need more measures that provide direct insight into what the individual physicians can do right now to modify the way they practice.

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Why don’t employers get educated and demand full transparency for what they are buying? Well, some do, but it’s hard. It’s challenging to compare health insurance benefits. It’s ten times harder to interpret the pharmacy benefits - which are a whole ‘nother shell game altogether. … I asked 10 doctors: Have you ever heard of a health insurance broker? All said “no.” ?Nor did any of them know how health insurance was sold in the United States. I was struck by the disconnect between those who deliver health care and those who sell it. It reminded me of what Senator Bill Frist, who is also a surgeon, said to me the day we met. Frist said doctors are educated in medicine but not in health care.

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Today, approximately 80% of Americans get their medications through a PBM. American businesses financing the coverage and the employees paying for their medications are usually oblivious to the price gouging. When people get frustrated that drug prices keep going up, they often point the finger at pharma bad boys like Martin Shkreli. More often, though, the price spikes are taking place right under their noses. … “Secrecy is how everyone in the drug supply chain makes so much money. The sad part is that patients are being asked to pay more and more of the higher and higher prices,” Jerry explained.