WEBVTT - How to Buy a Better Birth 0:00:04.840 --> 0:00:08.800 Having a baby in America is expensive. By one measure, 0:00:08.880 --> 0:00:11.240 the average cost for a normal delivery in the United 0:00:11.280 --> 0:00:15.320 States is eleven thousand dollars. That's more than twice as 0:00:15.400 --> 0:00:18.759 much as in Switzerland. It's even more expensive than the 0:00:18.800 --> 0:00:21.840 deluxe suite in the private wing of a London hospital 0:00:22.200 --> 0:00:25.240 where Kate Middleton and other British royals have given birth, 0:00:26.040 --> 0:00:29.480 and in the US the price can vary wildly depending 0:00:29.520 --> 0:00:32.680 on what hospital you go to, even within the same city. 0:00:34.000 --> 0:00:35.839 You might think that the high price would mean the 0:00:35.880 --> 0:00:39.520 care is superior, but that's not the case. The United 0:00:39.520 --> 0:00:42.760 States healthcare system has alarming rates of poor outcomes for 0:00:42.880 --> 0:00:48.840 mothers and their newborns. Welcome to Prognosis, Bloomberg's podcast about 0:00:48.840 --> 0:00:52.360 the future of health care. I'm your host Michelle fay cortes. 0:00:53.400 --> 0:00:56.280 Americans pay higher prices than people in other countries for 0:00:56.360 --> 0:01:00.560 similar medical services, and the most expensive services is are 0:01:00.680 --> 0:01:04.840 not necessarily the best. Bloomberg News health reporter John Tazzi 0:01:04.959 --> 0:01:07.400 looked at one health plan that's trying to use the 0:01:07.560 --> 0:01:10.360 millions of dollars it spends each year on births to 0:01:10.440 --> 0:01:21.040 lower costs and improve outcomes from others. Sarah Rothstein pays 0:01:21.080 --> 0:01:24.520 for a lot of babies. Well, she doesn't pay herself, 0:01:24.880 --> 0:01:27.560 but the health plan she runs does. My name is 0:01:27.560 --> 0:01:30.600 Sarah Rothstein, from the director of the thirty two Health Fund. 0:01:31.160 --> 0:01:33.560 That's a big union health plan based in New York. 0:01:33.959 --> 0:01:37.800 It's affiliated with the Service Employees International Union. So our 0:01:37.880 --> 0:01:42.080 union members are office cleaners, their security guards. They're building 0:01:42.160 --> 0:01:46.720 doormen and women building maintenance people. The union negotiates contracts 0:01:46.800 --> 0:01:49.840 with employers on behalf of its members. As part of 0:01:49.880 --> 0:01:53.560 those contracts, employers contribute money to the health fund to 0:01:53.640 --> 0:01:56.920 pay for workers medical care. If you live in a 0:01:56.960 --> 0:02:00.760 big Manhattan apartment building or your company rents office space 0:02:00.840 --> 0:02:03.800 in the city, you're probably paying for some of the 0:02:03.880 --> 0:02:07.840 union's medical expenses. The thirty two b J Health Fund 0:02:07.960 --> 0:02:11.480 spends more than a billion dollars each year on medical care. 0:02:12.120 --> 0:02:15.920 It covers about two hundred thousand people, both union members 0:02:15.960 --> 0:02:19.680 and their families, and every year some of those people 0:02:19.800 --> 0:02:23.640 have babies, And in our plan we pay for about 0:02:24.400 --> 0:02:27.480 births a year, nearly a thousand of which are in 0:02:27.680 --> 0:02:30.799 downstate New York and in New Jersey. Having a baby 0:02:31.000 --> 0:02:34.560 is the top reason for planned hospital admissions among members 0:02:34.600 --> 0:02:37.120 of the thirty two b J plan, and the fund 0:02:37.320 --> 0:02:40.239 spends more than twenty million dollars a year on those births. 0:02:41.280 --> 0:02:44.560 The fund hires an outside company that administers its plan, 0:02:44.919 --> 0:02:47.679 but the fund pays the expense of medical care itself, 0:02:48.400 --> 0:02:51.120 so Sarah wants to keep costs in check while getting 0:02:51.120 --> 0:02:55.000 the best care for plan members in Sarah and her 0:02:55.040 --> 0:02:59.280 team started analyzing the funds data on childbirth, and they 0:02:59.320 --> 0:03:03.520 found two big surprises. Sarah told me about it recently 0:03:03.639 --> 0:03:07.640 in her office on Eighteenth Street in Manhattan. The first 0:03:07.680 --> 0:03:11.640 big surprise was that prices for childbirth were all over 0:03:11.680 --> 0:03:14.000 the map. We could be paying ten thousand dollars or 0:03:14.000 --> 0:03:16.400 we could be paying thirty thousand dollars, depending on the 0:03:16.400 --> 0:03:22.600 hospital that someone had their baby at, same procedure, same procedure, 0:03:23.360 --> 0:03:27.799 same region, same health plan. The difference in costs rang 0:03:28.080 --> 0:03:31.880 from about ten thousand dollars to about thirty thousand dollars 0:03:31.919 --> 0:03:35.640 just for a vaginal delivery. Sarah says Union members were 0:03:35.680 --> 0:03:38.320 also surprised. They said, you know, we assume that some 0:03:38.400 --> 0:03:40.960 hospitals would cost a little bit more. Maybe they're in 0:03:41.000 --> 0:03:45.080 a nice location, maybe the facilities look a little bit nicer. 0:03:45.400 --> 0:03:48.160 But when you have some hospitals charging so much more 0:03:48.200 --> 0:03:51.040 than others. That makes us feel like we're being ripped off. 0:03:51.400 --> 0:03:54.560 The second thing Sarah discovered was that the plan had 0:03:54.600 --> 0:03:57.840 a really big problem with the quality of maternity care. 0:03:58.320 --> 0:04:04.000 Women giving birth experience serious, unexpected problems such as blood transfusions, 0:04:04.240 --> 0:04:07.680 kidney failure, or heart failure twice as often as the 0:04:07.760 --> 0:04:11.240 national average. She also found that women on the plan 0:04:11.440 --> 0:04:15.600 experienced a high rate of episiotomys. That's an incision to 0:04:15.680 --> 0:04:19.479 widen the vaginal opening. Experts say it should happen in 0:04:19.560 --> 0:04:23.000 only about five of births, but a quarter of the 0:04:23.040 --> 0:04:26.640 births that thirty two b J paid for involved epsiotomys, 0:04:27.200 --> 0:04:31.480 and of the deliveries were cesarean sections where the baby 0:04:31.560 --> 0:04:35.320 is surgically removed through the mother's abdomen. C sections are 0:04:35.440 --> 0:04:40.720 riskier and more expensive than vaginal births. Sarah was stunned 0:04:41.600 --> 0:04:45.040 the hospitals where her members were giving birth build themselves 0:04:45.120 --> 0:04:49.880 as world class medical institutions. We have several academic medical 0:04:49.960 --> 0:04:52.160 centers in New York. We have a lot of high 0:04:52.240 --> 0:04:55.839 quality care in New Jersey, and hospitals that advertise themselves 0:04:55.880 --> 0:04:59.520 as providing only the highest quality care and only care 0:04:59.600 --> 0:05:02.800 that's my really necessary, but the hospitals didn't seem to 0:05:02.839 --> 0:05:06.320 measure up to those promises, and so it was really 0:05:06.360 --> 0:05:09.360 shocking to us to see that the hospitals that are 0:05:09.400 --> 0:05:12.760 members were using, which advertise themselves as some of the 0:05:12.760 --> 0:05:17.000 best quality hospitals in the country, aren't necessarily the safest 0:05:17.000 --> 0:05:21.720 for our members. Sarah found costs that varied widely among hospitals, 0:05:22.120 --> 0:05:25.880 and he found big quality problems, and the most expensive 0:05:25.920 --> 0:05:33.280 care wasn't necessarily better. What we've been finding after reviewing 0:05:33.320 --> 0:05:35.640 a number of episodes is that there is not a 0:05:35.680 --> 0:05:39.160 correlation between cost and quality. So higher cost doesn't mean 0:05:39.240 --> 0:05:43.400 higher quality, lower cost doesn't mean lower quality. This isn't 0:05:43.440 --> 0:05:46.240 just a problem when it comes to maternity care, and 0:05:46.320 --> 0:05:48.560 it's not just a problem for the thirty two b 0:05:48.720 --> 0:05:52.000 J Fund. Across the health care system, the price of 0:05:52.080 --> 0:05:58.040 care doesn't reflect how good the care is. Let's step 0:05:58.080 --> 0:06:00.480 back for a minute to consider how health care prices 0:06:00.520 --> 0:06:04.279 are set in the United States. Some prices are set 0:06:04.320 --> 0:06:08.160 by the government and programs like Medicare and Medicaid. These 0:06:08.160 --> 0:06:12.000 public programs are giant purchasers of health care. They spend 0:06:12.200 --> 0:06:16.000 hundreds of billions of dollars a year. They have a 0:06:16.040 --> 0:06:19.039 lot of buying power, so the government can decide how 0:06:19.120 --> 0:06:23.000 much to pay. On the other hand, if you're one 0:06:23.040 --> 0:06:26.240 of the twenty eight million Americans with no health insurance, 0:06:26.600 --> 0:06:30.360 you have zero buying power. The supplier of medical care, 0:06:30.640 --> 0:06:34.000 a hospital or doctor, can set their prices as high 0:06:34.040 --> 0:06:38.000 as they like. Unless you qualify for a charitable discount. 0:06:38.320 --> 0:06:44.400 That's the price, and you're stuck with it. Private health plans, 0:06:44.480 --> 0:06:46.960 like the thirty two b J Health Fund exists in 0:06:47.040 --> 0:06:51.680 between these two extremes. Employers and unions higher health insurance 0:06:51.680 --> 0:06:56.160 companies to negotiate with medical providers. The prices they pay 0:06:56.279 --> 0:06:59.480 are higher than what the government pays because these groups 0:06:59.640 --> 0:07:03.480 don't have as much buying power, but private health plans 0:07:03.600 --> 0:07:06.400 usually pay less than what a hospital would charge someone 0:07:06.520 --> 0:07:10.560 with no insurance at all. Each of these negotiations between 0:07:10.600 --> 0:07:15.400 health plans and medical providers is separate and hidden. The 0:07:15.440 --> 0:07:19.040 Trump administration is trying to force hospitals and insurers to 0:07:19.200 --> 0:07:24.520 make their privately negotiated prices public. The industry is fighting 0:07:24.520 --> 0:07:28.840 the plan. Hospitals and insurers want to keep these rates secret. 0:07:29.360 --> 0:07:32.880 They argue that their contracts are private and revealing the 0:07:32.960 --> 0:07:37.760 details could actually put costs up. Some experts say this 0:07:37.960 --> 0:07:41.280 lack of transparency contributes to a lot of the crazy 0:07:41.320 --> 0:07:44.200 price differences that we see in healthcare. But if you 0:07:44.320 --> 0:07:49.520 look at how much c sections costs, both nationally and 0:07:49.640 --> 0:07:54.200 in any given city, there's a huge range, from as 0:07:54.240 --> 0:07:58.280 low as four or five thousand dollars in Knoxville, Tennessee, 0:07:58.640 --> 0:08:03.640 to as high as forty dollars in San Francisco. This 0:08:03.800 --> 0:08:08.120 is Nile Brennan. I'm the CEO of the Healthcare Cost Institute. 0:08:08.640 --> 0:08:12.160 Nile's research group analyzes data from health in turns companies 0:08:12.240 --> 0:08:16.240 to better understand costs. The data is anonymized, so you 0:08:16.280 --> 0:08:21.560 can identify patients, inferers, or particular hospitals. But Nile can 0:08:21.560 --> 0:08:24.480 look at the prices that inferrors pay hospitals in the 0:08:24.520 --> 0:08:28.560 private market, the amount of money that actually changes hands. Then, 0:08:28.560 --> 0:08:32.240 if you look at San Francisco, just the San Francisco area, 0:08:33.440 --> 0:08:36.520 the price of a C section can range from fifteen 0:08:36.559 --> 0:08:41.720 thousand dollars to again forty dollars. Just like Sarah found 0:08:41.760 --> 0:08:45.400 in New York, prices are all over the place. In 0:08:45.440 --> 0:08:48.840 a functioning market, Nile says, buyers would gravitate to the 0:08:48.880 --> 0:08:55.839 lower priced services. So imagine a world where uh computer 0:08:56.160 --> 0:09:00.000 or a Toyota camray you know, could range from fifty 0:09:00.200 --> 0:09:06.559 thousand dollars. There would be absolute outrage, right and everybody 0:09:06.559 --> 0:09:12.319 would you know, flock to the fifteen dollar problems. Even 0:09:12.360 --> 0:09:16.160 simple commodity services like basically ab tests that are performed 0:09:16.240 --> 0:09:20.840 all the time don't have standard prices. We found that 0:09:21.040 --> 0:09:26.520 the prices of blood tests in our data varied from 0:09:26.600 --> 0:09:29.719 you know, as low as twenty or thirty dollars to 0:09:30.600 --> 0:09:35.720 as high as you know, nine dollars nine hud dollars plus. 0:09:41.800 --> 0:09:45.080 Healthcare providers point out that they lose money on a 0:09:45.080 --> 0:09:49.280 lot of the patients they see. Government programs like Medicare 0:09:49.320 --> 0:09:52.760 and Medicaid set prices, and hospitals say they often don't 0:09:52.760 --> 0:09:57.200 pay enough to cover expenses. Hospitals also point out that 0:09:57.280 --> 0:10:00.280 they have to treat people in emergencies regard us of 0:10:00.320 --> 0:10:03.480 the ability to pay. The industry has to comply with 0:10:03.679 --> 0:10:07.040 complex regulations, and it often can't control the cost of 0:10:07.080 --> 0:10:11.920 its inputs like labor or medication. Hospitals say the higher 0:10:11.960 --> 0:10:15.600 prices they sometimes charge to commercial health plans are necessary 0:10:15.640 --> 0:10:19.880 to keep the doors open. The American Hospital Association points 0:10:19.880 --> 0:10:23.360 out that the price of similar services varies among hospitals 0:10:23.480 --> 0:10:27.240 because of factors particular to each facility and episode of care. 0:10:28.280 --> 0:10:31.840 Some hospitals may treat patients with more complex needs or 0:10:31.880 --> 0:10:38.160 have additional expenses related to training medical residents. The average 0:10:38.160 --> 0:10:41.280 person who walks into a hospital or doctor's office won't 0:10:41.360 --> 0:10:44.160 know ahead of time what they'll be charged for a 0:10:44.160 --> 0:10:48.280 given test or procedure. You typically pay the same copay 0:10:48.480 --> 0:10:51.600 to your health plan. If you have a deductible, you 0:10:51.640 --> 0:10:55.640 may have to pay the entire amount, but you might 0:10:55.679 --> 0:10:58.400 not find out that you owe nine dollars rather than 0:10:58.440 --> 0:11:01.480 twenty dollars for the same blood test until the bill 0:11:01.679 --> 0:11:08.800 comes weeks later. Health insurance companies could exclude high cost providers, 0:11:08.920 --> 0:11:12.040 and sometimes they do, but they can't do that in 0:11:12.120 --> 0:11:16.000 markets where a big hospital system dominates, and even in 0:11:16.080 --> 0:11:20.160 more competitive markets, they're often reluctant to cut powerful providers 0:11:20.280 --> 0:11:25.040 out of their networks. Remember, Niles data knows the amounts 0:11:25.160 --> 0:11:29.480 that insurance companies actually pay, and it shows wild price 0:11:29.559 --> 0:11:34.560 spreads across all the services he's looked at. C sections, 0:11:35.440 --> 0:11:43.120 lab tests, mammograms, m ris um all exhibit in incredible 0:11:43.840 --> 0:11:50.880 and unwarranted variation that can really only be explained by 0:11:50.880 --> 0:11:54.000 the fact that people have realized that they can get 0:11:54.040 --> 0:11:58.360 away with it. Some prices are higher because people can 0:11:58.400 --> 0:12:01.360 get away with it. At the thirty two b J 0:12:01.559 --> 0:12:06.120 Health Fund, Sarah Rothstein examined what her health plan was spending, 0:12:06.559 --> 0:12:11.319 and she came to a similar conclusion. Our theory, um 0:12:11.360 --> 0:12:13.120 you know, which we can't prove because we don't have 0:12:13.200 --> 0:12:16.880 access to the contracts between the hospitals and the insurers, 0:12:17.520 --> 0:12:19.760 is that some of the health systems are able to 0:12:19.840 --> 0:12:24.400 use their market power to demand higher prices. Giving birth 0:12:24.520 --> 0:12:28.120 is a more complex procedure than allowed test, but Sarah said, 0:12:28.160 --> 0:12:32.000 the Health Fund sees variation in prices across procedures big 0:12:32.040 --> 0:12:35.840 and small, and the Fund doesn't know how it's insurance 0:12:35.880 --> 0:12:39.880 carrier negotiates those rates with hospitals. Unless we were to 0:12:39.960 --> 0:12:43.600 go to the hospitals directly and negotiate a price, we 0:12:43.640 --> 0:12:46.280 don't know how the prices are set. So, for example, 0:12:46.400 --> 0:12:49.240 if our member has a baby at the hospital, we 0:12:49.360 --> 0:12:53.040 don't know if there is a different price for a 0:12:53.120 --> 0:12:56.199 vaginal delivery or a C section. We don't know if 0:12:56.200 --> 0:12:58.480 the doctors are getting paid more if they're performing in 0:12:58.480 --> 0:13:02.160 a psiotomy than if they aren't. The Health Fund is 0:13:02.200 --> 0:13:05.160 paying the bills, but it doesn't know how prices are 0:13:05.160 --> 0:13:08.920 set or whether doctors have an incentive to provide certain 0:13:09.000 --> 0:13:14.199 types of care that could be riskier for women. And 0:13:14.440 --> 0:13:17.520 last year, the thirty two b J Health Fund decided 0:13:17.559 --> 0:13:23.760 to try to change that. Sarah wants to use the 0:13:23.800 --> 0:13:27.360 health Plans buying power, the billion plus dollars it spends 0:13:27.360 --> 0:13:30.880 on medical care every year to reward hospitals that are 0:13:30.880 --> 0:13:35.479 providing high quality care at lower prices, and in particular, 0:13:35.840 --> 0:13:38.120 he wants to use the plans clout in the market 0:13:38.280 --> 0:13:43.000 to improve maternity care. The first thing the Health Fund 0:13:43.000 --> 0:13:46.240 did was give its members an incentive to avoid the 0:13:46.320 --> 0:13:50.280 highest cost facilities in the New York area. That began 0:13:50.400 --> 0:13:55.400 in April. We now have preferred hospitals and non preferred hospitals, 0:13:55.400 --> 0:13:57.199 and having a baby at a preferred hospital as a 0:13:57.240 --> 0:14:00.080 hundred dollars, having a baby at a non prefer at 0:14:00.160 --> 0:14:02.760 hospital is a thousand dollars, So that's a big price difference. 0:14:03.240 --> 0:14:06.760 That wasn't just for maternity care. The health Plan told 0:14:06.760 --> 0:14:09.959 its members that they would face thousand dollars co pays 0:14:09.960 --> 0:14:14.360 for planned in patient services at several big hospitals such 0:14:14.360 --> 0:14:17.600 as New York Presbyterian because it found the prices at 0:14:17.600 --> 0:14:23.080 those facilities to be significantly higher than other hospitals. At 0:14:23.120 --> 0:14:26.920 other facilities, such as Mount Sinai, the normal hundred dollar 0:14:27.000 --> 0:14:32.800 copay applies. The Plan was careful to explain to members 0:14:32.880 --> 0:14:36.120 why co pays at certain hospitals went up by so much. 0:14:37.000 --> 0:14:41.280 One mailing showed how the plans costs compared at different hospitals. 0:14:41.840 --> 0:14:44.080 The average cost for having a baby at a non 0:14:44.120 --> 0:14:48.840 preferred hospital was seven thousand dollars more than at preferred hospitals. 0:14:50.280 --> 0:14:53.360 The Plan reminded union members that their employers pay up 0:14:53.400 --> 0:14:56.960 to twenty thousand dollars a year for healthcare, and rising 0:14:57.000 --> 0:15:05.400 costs left less money for wages. Then last summer, Sarah 0:15:05.400 --> 0:15:07.960 announced that the thirty two b J Plan would launch 0:15:08.040 --> 0:15:11.240 a program to encourage its members to give birth at 0:15:11.280 --> 0:15:14.920 the best performing hospitals, the ones that would deliver high 0:15:15.000 --> 0:15:19.720 quality at reasonable prices. The plan calls it the Better 0:15:19.760 --> 0:15:25.120 Birth Maternity Program. Sarah invited hospitals to apply to join it, 0:15:25.520 --> 0:15:28.240 and to get into the program, they have to reveal 0:15:28.480 --> 0:15:32.280 detailed information about their practices. You really wanted to get 0:15:32.400 --> 0:15:35.520 under the hood of the data and understand what was 0:15:35.640 --> 0:15:38.600 behind the good numbers. At the hospitals that were performing 0:15:38.640 --> 0:15:42.600 better and how they were holding their providers accountable. UM, 0:15:42.640 --> 0:15:45.440 so really kicking the tires to make sure they were 0:15:45.480 --> 0:15:48.600 doing all of the hard work that leads to better 0:15:48.720 --> 0:15:51.960 data and better outcomes. Um to make sure that it 0:15:52.000 --> 0:15:55.160 wasn't just by luck or by hoppenstance. Sarah shared a 0:15:55.200 --> 0:15:58.040 copy of the request that she sent to hospitals. It's 0:15:58.120 --> 0:16:02.560 nineteen pages and includes uSens of detailed questions. It asks 0:16:02.640 --> 0:16:06.840 about whether the hospitals limit women's health services like sterilization 0:16:07.040 --> 0:16:11.520 or contraception. It asks if factation consultants and duels are 0:16:11.560 --> 0:16:15.160 on staff. It asks for detailed data on the kind 0:16:15.200 --> 0:16:18.160 of serious harm to mothers that the plan is trying 0:16:18.200 --> 0:16:21.960 to reduce. They had to meet certain quality criteria off 0:16:22.000 --> 0:16:25.320 the bat, and then they also had to provide us 0:16:25.360 --> 0:16:29.640 with an enormous amount of data as well as providing 0:16:29.680 --> 0:16:33.160 attestation that they're adhering to the best practices as set 0:16:33.200 --> 0:16:36.720 forth by national and state organizations who have done a 0:16:36.760 --> 0:16:39.000 lot of work to figure out what leads to higher 0:16:39.080 --> 0:16:43.440 quality maternity care. She even asked about some things that 0:16:43.520 --> 0:16:48.200 the hospitals hadn't looked at themselves. The funded nudged hospitals 0:16:48.240 --> 0:16:51.360 to provide data on maternal harm in terms of race 0:16:51.400 --> 0:16:56.360 and ethnicity. Women of color experience higher rates of maternal harm, 0:16:56.400 --> 0:16:59.200 a fact that's drawn increasing attention in the medical world. 0:16:59.680 --> 0:17:02.640 One of the areas for concern for US was racial 0:17:02.680 --> 0:17:07.679 and ethnic disparities amongst maternal outcomes. Their significant data that 0:17:07.720 --> 0:17:10.560 shows that black women are particularly at risk and other 0:17:10.600 --> 0:17:12.840 women of color are a much higher risk for adverse 0:17:12.880 --> 0:17:15.320 outcomes when they're having a baby. But when the Fund 0:17:15.400 --> 0:17:19.280 asked hospitals how often women of color suffered adverse events 0:17:19.359 --> 0:17:22.639 related to childbirth, some of them couldn't answer, and a 0:17:22.720 --> 0:17:25.600 number of hospitals said, we want to work to do this, 0:17:25.720 --> 0:17:28.399 will commit to getting this data to you in the future, 0:17:28.720 --> 0:17:30.480 but we don't have the data broken out that way 0:17:30.560 --> 0:17:34.040 as of today. And that was interesting for us to hear, 0:17:34.200 --> 0:17:37.160 because if you're not measuring something, you can't figure out 0:17:37.200 --> 0:17:38.800 if you have a problem or if you have to 0:17:38.880 --> 0:17:41.960 fix it. In the fall, Sarah met in person with 0:17:42.040 --> 0:17:46.040 hospital leaders to explain why the third QBJ Health Fund 0:17:46.200 --> 0:17:49.480 wanted all this information and to learn more about how 0:17:49.520 --> 0:17:53.120 the facilities tried to ensure good outcomes in their maternity care. 0:17:53.359 --> 0:17:56.359 And so they've been good conversations. UM, we've learned a 0:17:56.359 --> 0:18:01.040 lot about how hospitals are holding prov witers accountable, how 0:18:01.080 --> 0:18:04.720 they're changing clinical models in their hospital, and they've learned 0:18:04.760 --> 0:18:08.160 a lot about a purchaser who is really concerned about 0:18:08.160 --> 0:18:10.879 the well being of its plan participants. When I spoke 0:18:10.920 --> 0:18:14.000 to Sarah in January, the plan hadn't yet announced which 0:18:14.040 --> 0:18:17.200 providers would be included, but thirty T b J will 0:18:17.280 --> 0:18:21.320 soon start telling its members which hospitals, doctors and midwives 0:18:21.359 --> 0:18:24.919 have met the standards to join the Better Birth Program, 0:18:24.960 --> 0:18:27.280 and it will offer some perks for mothers to go 0:18:27.440 --> 0:18:30.920 to these providers. The plan will reba the hundred dollar 0:18:31.000 --> 0:18:34.040 copay that members would otherwise have to pay. They'll also 0:18:34.080 --> 0:18:36.680 be a basket of stuff for mom and baby, so 0:18:37.119 --> 0:18:41.919 mom will get a nice gown, she'll get some birds, bees, products, um, 0:18:42.080 --> 0:18:44.159 things that will maybe make her feel a little bit 0:18:44.160 --> 0:18:46.520 better after delivery. And then there'll be a choice of 0:18:46.520 --> 0:18:50.080 a big thing for baby, so could be a baby carrier, 0:18:50.200 --> 0:18:53.640 a car seat. Thirty T b J will also promote 0:18:53.680 --> 0:18:56.960 the program to women on its plan. The Health Fund 0:18:57.040 --> 0:18:59.520 will send mailings and emails a few times a year 0:19:00.080 --> 0:19:03.360 directing people to a website with information about the hospitals 0:19:03.400 --> 0:19:07.120 in the program and why they've been selected. Sarah says 0:19:07.200 --> 0:19:10.400 that some members in focus groups said they want help 0:19:10.480 --> 0:19:14.160 accusing the best providers, and across the board they said 0:19:14.480 --> 0:19:17.840 they really trust us to recommend programs to them. They 0:19:17.920 --> 0:19:21.720 also really had a range of experience in maternity care. 0:19:22.040 --> 0:19:24.240 Some people who had had a first or second childhood 0:19:24.240 --> 0:19:28.879 good experiences, some people had really bad experiences, and a 0:19:28.960 --> 0:19:31.199 number of people said, I really don't know how to 0:19:31.240 --> 0:19:34.760 get the information that I need um and would welcome 0:19:34.800 --> 0:19:38.040 the Health Fund providing me with this information and figuring 0:19:38.080 --> 0:19:40.280 out what are some of the good choices for me 0:19:40.359 --> 0:19:43.440 to make. Over the next few years, Sarah and her 0:19:43.480 --> 0:19:47.000 staff will track how many women accused to use providers 0:19:47.000 --> 0:19:50.359 in the new program, and they'll also measure rates of 0:19:50.440 --> 0:19:54.400 c sections. Appease theotomies and incidents of harm to mothers. 0:19:55.359 --> 0:19:59.280 By steering members to the best, lowest cost providers, Sarah 0:19:59.280 --> 0:20:03.040 hopes to raise the bar across the entire market. There's 0:20:03.080 --> 0:20:06.760 a role for purchasers to really push healthcare providers on 0:20:06.920 --> 0:20:10.440 quality that they're not necessarily being pushed by other entities, 0:20:10.800 --> 0:20:13.640 and this helps us serve our members better as well 0:20:13.680 --> 0:20:18.400 as the rest of the public. What the thirty two 0:20:18.400 --> 0:20:21.720 b J Fund is doing is unusual, but it's worth 0:20:21.800 --> 0:20:27.359 asking why it's so extraordinary. Lots of big, sophisticated companies 0:20:27.480 --> 0:20:31.520 spend plenty of money on healthcare, they have an incentive 0:20:31.600 --> 0:20:35.280 to spend it wisely, and they all hire insurance companies 0:20:35.359 --> 0:20:39.360 to administer their plans. Those insurers could apply the same 0:20:39.480 --> 0:20:42.080 kind of pressure on hospitals that the thirty two b 0:20:42.200 --> 0:20:45.920 J Fund is, but Sarah said that really hasn't happened 0:20:46.000 --> 0:20:48.919 from Eternity Care, and even the hospitals that are interested 0:20:48.960 --> 0:20:50.959 in participating have told us they've never been asked by 0:20:51.000 --> 0:20:54.560 anyone for that level of quality data, which was shocking 0:20:54.600 --> 0:20:57.960 to us. Um and a number of hospitals also said that, 0:20:58.600 --> 0:21:01.359 you know, until recently, they themselves weren't looking at the 0:21:01.400 --> 0:21:03.960 quality data from an Alternity Care, which was shocking to 0:21:04.040 --> 0:21:07.119 us as well. For much of the last twenty years, 0:21:07.280 --> 0:21:09.800 there's been a lot of talk about how Americans need 0:21:09.880 --> 0:21:14.680 to be smarter consumers of health care. Employers raised health 0:21:14.720 --> 0:21:18.280 insurance deductibles so people would have more skin in the 0:21:18.320 --> 0:21:23.240 game and shop for care more carefully. They've effectively asked 0:21:23.280 --> 0:21:26.639 individuals to use their buying power to make the market 0:21:26.680 --> 0:21:30.680 work better, but people don't have good information on which 0:21:30.720 --> 0:21:33.919 providers are the best or how much they cost. A 0:21:33.960 --> 0:21:37.840 lot of the information that moms would need is hard 0:21:37.880 --> 0:21:41.280 to get from hospitals. It's not publicly available, and even 0:21:41.280 --> 0:21:44.320 a sophisticated consumer might have a hard time figuring out 0:21:44.359 --> 0:21:46.880 how to wade through hundreds of data points to figure 0:21:46.920 --> 0:21:49.520 out what the right facility is for them. And the 0:21:49.560 --> 0:21:52.960 employers that pay for healthcare, for the most part, haven't 0:21:53.000 --> 0:21:56.719 been doing what Sarah is doing using their own collective 0:21:56.720 --> 0:22:00.240 buying power to try to improve the health care system. 0:22:00.240 --> 0:22:03.680 It's ultimately our goal to have equally high quality care 0:22:03.800 --> 0:22:06.960 and low prices everywhere so that members can go wherever 0:22:07.040 --> 0:22:10.720 they want. But until that happens, we think it's to 0:22:10.800 --> 0:22:15.280 our advantage and to our plan participants advantage to steer 0:22:15.359 --> 0:22:19.080 plan participants to health care facilities that are lower cost 0:22:19.119 --> 0:22:25.640 and high quality. Higher costs don't mean better care. There 0:22:25.680 --> 0:22:29.760 are already some healthcare providers that deliver good care at 0:22:29.800 --> 0:22:33.800 lower prices. Their proof that the system doesn't have to 0:22:33.840 --> 0:22:36.320 be as expensive as it is and that it can 0:22:36.359 --> 0:22:43.880 perform better than it often does. On this season of Prognosis, 0:22:44.240 --> 0:22:46.600 We've looked at a lot of the ways the American 0:22:46.640 --> 0:22:50.280 health care system is broken, how it costs too much, 0:22:50.600 --> 0:22:54.399 and how it often fails people. It's a complicated problem 0:22:54.400 --> 0:22:58.000 and there's no single solution, but one place to start 0:22:58.200 --> 0:23:01.200 is with the entities were ultimately paying for a system 0:23:01.240 --> 0:23:05.399 that doesn't work very well. A few big purchasers of 0:23:05.400 --> 0:23:09.440 healthcare look carefully at where their dollars are going. If 0:23:09.480 --> 0:23:12.399 more of them did, maybe we'd all feel better about 0:23:12.440 --> 0:23:31.359 what we're paying for. And that's it for this season 0:23:31.359 --> 0:23:39.280 of Prognosis. Thanks so much for listening. We'll be back 0:23:39.280 --> 0:23:41.840 with the new season soon, but until then, you can 0:23:41.880 --> 0:23:44.000 see what our health team is up to by going 0:23:44.040 --> 0:23:50.919 to www dot Bloomberg dot com backslash Prognosis. Do you 0:23:50.920 --> 0:23:53.240 have a story about healthcare in the US or around 0:23:53.240 --> 0:23:55.439 the world, We want to hear from you. We're on 0:23:55.480 --> 0:23:59.040 Twitter at bay Cortes or at Jaytaws. If you're a 0:23:59.040 --> 0:24:01.360 fan of this episode, please take a moment to rate 0:24:01.400 --> 0:24:04.280 and review us. It really helps new listeners find the show, 0:24:04.720 --> 0:24:08.240 and don't forget to subscribe. This episode was produced by 0:24:08.320 --> 0:24:11.960 Laura Carlson. Our story editor was Rick Shine. Special thanks 0:24:11.960 --> 0:24:15.480 to Drew Armstrong Health care team leader and Francesca Levy, 0:24:15.560 --> 0:24:19.040 whose head of podcasts at Bloomberg, thanks so much for listening.