EP457: It’s a Big Thing: Medical Spread Pricing. So, Let’s Talk About Contract Transparency, With Cynthia Fisher

Relentless Health Value™

In this episode of 'Relentlessly Seeking Value,' host Stacey Richter is joined by healthcare entrepreneur Cynthia Fisher to discuss the crucial issue of medical spread pricing and the need for contract transparency.

Fisher explains how hidden fees and spread pricing by middlemen are leading to substantial overcharges for employers and patients in the U.S. healthcare system. The conversation delves into recent lawsuits that highlight these practices, the legislative strides made to enforce price transparency, and how transparency can potentially transform the industry.

Look, this is a thing now, medical spread. And similar to how PBM spreads adds up to millions, billions of dollars, medical spread is not change in the couch cushions. Did you see the lawsuit against Cigna? Cynthia Fisher mentions it in the conversation that follows. Spoiler alert, here’s the numbers: Self-insured employer paid $4 million for a claim.

There’s a slide on this Cynthia Fisher gave me, by the way, if you want to see all this written out. So, the employer pays $4 million. The provider was paid—drumroll, please—$876,000. I’m pausing so that sinks in: $4 million paid by the employer; $876,000 of that makes it across the trench to the provider.

To view the meme we created for how carriers are learning to do spread pricing from the PBMs, visit our show notes page below. (continued after the links below)

=== LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP457

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Fisher emphasizes the importance of employers and unions demanding accountability, using existing laws to unveil true pricing, and advocates for a revolution in healthcare to ensure fair, equitable, and transparent billing. Insights are also shared from industry experts who were previous guests including Chris Deacon, Justin Leader, and Andreas Mang. You can find the links in the show notes on our site.

09:03 What is the goal of PatientRightsAdvocate.org?

10:28 Is American competitiveness being affected by healthcare spend?

13:47 Why is transparency a root cause to healthcare costs?

15:11 What’s going on across the country to empower transparency in healthcare?

19:31 “I think people are fed up.”

21:22 The Cigna lawsuit in California.

26:36 How do employers navigate contracts against anti-steering?

28:54 EP419 with Andreas Mang.

29:33 EP452 with Cora Opsahl and EP453 with Claire Brockbank.

29:45 EP433 with Justin Leader.

You can learn more at PatientRightsAdvocate.org.