As you can in stating your question, and before you do that, identify yourself and your affiliation if you have one. Yes, sir . Hi. My name is steven spitz. I have two related questions on costs. One, i had an experience in the hospital where they said that i needed a certain common procedure, and i asked what the price was. I gave them my insurance information. And they came back and they said, we dont know. Id like to know how common that is, and what is being done to try to let folks actually know what something costs . I might add, i had at the time a high deductible so it was an important question about my outofpocket costs. The second question is Medicare Part b, when i noted it in the biography to mr. White, was involved with in 2003 has a provision prohibiting the government from negotiating prices with the drug companies. And my question is why is that bill in the law . Do you want to take that one, ed . Why dont you start. Ill do the first one, and the second one real quick. The first one was, why cant they tell me what the price is . Like i said you know, forget about the email. Ask them about what a price is and its like getting trade secrets out of cuba, right . Its next to impossible. What were seeing is that what the price is, and what i owe are two different questions, right . And so if i have coverage, i think a lot of the plans are really good at estimating your costs. But sometimes not always. For medicare, the vast majority of people have thirdparty coverage. And so it varies what you owe. But theres a bill moving through the house actually part yours, so i guess its in the senate now that said for medicare, you have to provide consumers a max out of pocket across the hospital outpatient setting, and ambulatory surgery center. What is going to be exciting is, as more data comes into the system, well be able to parse this and cut it and slice it so i can tell you if youre on medicare, this is exactly what youre going to owe for this procedure at this facility. If youre insured in the commercial market, this is what youre going to owe. If youre uninsured, this is what youre going to owe. The price you pay is depending on what type of coverage you do or dont have. Thats kind of the first question. The second question is hhs is prohibited under part b from revealing drug prices. The private sector is not. Managed care and Health Insurers aggressively negotiate the costs in part d. The interesting thing when we enacted that law, we talked to cbo about that specific provision. Getting in the middle of these negotiations, the private sector negotiations to get the drug discounts, versus letting the folks who do this on a daily basis negotiate the discount in the private sector. They said if you had that provision in there, it probably would mess with the negotiations. But you definitely wouldnt save any money. And if you repealed that provision in the law today what cbo will tell you is, it will not save a single dime. The reason is, those ppms and those health plans are already negotiating the discounts. And theyre already being passed on to consumers. Thats why thats one of the reasons we did it. Joel going back to the first part of that question. Someone sent forward a question on a card, suggestion, actually after a long description of a situation to which it would apply, is it possible for providers to get access to Health Plan Cost calculators . So that they are able to inform consumers about their expected outofpocket costs before the services are rendered . Is that a practical possibility . Natalie, or joel . Or for that matter anybody else on the panel . You know i wouldnt say its common place today. Its definitely something that were exploring. Its that whole inoffice stuff. And i remarked early on about how we dont want to inspect relationships, but certainly how do we make more decisionmaking tools available at the point of service. So that when youre taking out your script, or comparing different Treatment Options that you have i wouldnt say its common place i would certainly say thats where the market would like to move. One caveat, though. From the consumer perspective, some of this matters too, how the claim is submitted. So we saw this in the discussion around Preventive Services when i talked about the confusion there about what you may be able to access as a consumer without cost sharing. Part of it is how its submitted and part of it is how its paid by the carrier. How that flows may dictate how you have a copay for that service. I think this comes up regularly. Thats another sort of unknown in the past way from the care that you received to the bill that you get. Yes, go right ahead. Im dr. Caroline popham. Im a primary care physician. Just to answer the gentlemans question about price price is proprietary information. Every Insurance Company negotiates a different price with every provider or every large provider, hospital. So the price is different depending on not what your plan is, but who your insurance is. The Insurance Companies dont want other Insurance Companies to know what kind of a deal they got from a big hospital. So that wont go away. My question is unrelated to that. I have two. A quick one for rebecca. You said that surveys show that Health Insurance providers are less trusted. Im wondering where that information is where you got it from . The source . I want to make sure this is on. I can share that with you. I think it was it was from numerous sources. But im happy to share that with you. I think it was on my slide that its node. Thats been declining over decades. Still some of the most trusted providers are the Health Care Professionals themselves. But weve seen this gradual decline with health plans. Natalie one of your slides has makes the same point, right . That insurers are pretty far down there. Maybe if you had that source, you could provide it as well. Yes. There are plenty of publicly available sources. I think its for the skepticism from institutions in general, that has commanded criticism with respect to the trust issues. I think because there is so much opaqueness around cost and how that whole sector works. You had another question caroline . A real question. Something that hasnt been mentioned at all. You assume that people know what they want or theyll recognize it when they see it at least. And behavioral economics has shown that in fact, with regard to health, people have really no idea about what they need, except for chronically ill people who know what their conditions are, know what medications theyre taking, know what they need. Better than a healthy person. For example its said that women are much more afraid of Breast Cancer than they are cardiovascular disease. But cardiovascular is a much bigger and more likely threat than Breast Cancer. So they dont know what they need. How can they choose it . I would say thats a question were trying to answer. So again, everybodys going to have their different take on what they think they might need, or what theyre most worried about. So thats why information needs to be presented in various ways, so that consumers can look at the difference whether its Preventive Care, whether its maternity care, whether its joint replacement. Youre right, they dont know what they dont know. Thats right. And the sensible thing to do then is to give a comprehensive plan for everybody. Like apparently they do at the california exchange. I think thats what the gentleman said last week, or the week before. That the plans were standardized. Standardized to the degree that with a certain set of them you can get a bunch of Services Without having to meet your deductible first. You still have the actuarial value, the general level of generosity. Then they come with the deductibles, as joel was saying. So for the silver level plan is at 70 , av is far lower than the typical employer plan which is 80 or 85 or higher. That means you have higher outofpocket costs. I believe in california there is a certain set of services you get without having to meet your deductible. For a hell tifl healthy person that will be different from the people who dont see the value of their Health Insurance when they dont know they can get three primary care doctors i thought it was much more standardized than that. Were you there . Do you remember . Its two different questions. I think it was everything but specialty drugs. Highcost things. There were a bunch of things primary care visits prescription drugs. The transcript from that briefing is on our website by the way. I think were here actually, i think this gentleman was in line first. Then two people over here. And then well go back this way. Thank you very much. Bob rhodes, bmj. We have consumers are really drowning in choices. And options there. One thing the system tried to do was with Preventive Care at least, limit the package and define it a little better. We heard today that they may not have done that good a job here. I guess my question is primarily, is there any rule for simplifying and standardizing what insurers can offer and how they can offer it . Wow. The actuarial value is supposed to be a way that bucket plans in big terms, like the relative generosity, by levels i touched on this. One of the requirements for all plans is there has to be a meaningful difference in the marketplace. But that leaves a lot of wiggle room. The kinds of things theyre doing in california or other states, to limit the number of plans, or products any given carrier can offer or to standardize them so some sets cover the same things in the same way. Thats certainly within the authority of the marketplaces. My actual reason why i said wow was, i would argue the other way. I think people like choices. I think when you think about someone with Breast Cancer, versus someone who has cardiovascular disease versus somebody who has cancer theyre going to value Different Things in different plans. One of the reasons i think we see well i think the Affordable Care act was very good at saying plans have to do x, y and z. And the result of that has been limiting options for plans in order to offer lower prices. Thats why were seeing some of the higher cautionary in the plans. I think that to the extent that plans can do a better job explaining the nuances and the difference in their coverage, that will be very important. But i think limiting choices is probably the opposite direction, at least that i would say we should go because health care is so personalized. Its becoming increasingly personalized. As we develop those cures and therapies for cancer cardiovascular disease, not further constrict it. I would also agree with that. Even though i talked about how consumers can be some consumers can be overwhelmed with choice. We do like our choices. And everybodys in a different situation. And also, their threshold on risk really vary. Again, the answer is how do you present those choices. You were talking about the framework for choice. And presumably there are standards for the optimal size of the choice universe for individual consumers. Is that fair . Yes thats correct. And also, i talked about how we present that information to consumers. And what you present first is really important, because consumers often, even though we want to allow all that customization, theres been studies done that show consumers dont always go in and customize it. So how you present it the default position is really important. Whether its showing the premium, whether its the deductible, or Preventive Services. Not to pile on but i think its a little more nuanced in that we talk about the paradox of choice. When youre overwhelmed, you cant distinguish, it adds to your frustration. So its about sort of curateing the highly relevant options where its clear in what the tradeoffs are between them. Its having choices, but youve got to know what they are. Theyve got to be relevant to you. Yes sir . My name is ken sharman from virginia. We predominantly help people who are below 40 poverty level. People who have low Health Insurance lat rasy. The question to the group is why not work with Insurance Companies at reducing the complexity and jargon to educate hess consumers on some of this jargon and try to get the consumers to learn the pro program. Yeah. You know, thats precisely what were doing. Were actually going letter by letter, screen by screen, and really looking at it through the lens of the consumer which is quite new. Ill say, for our entire sector. You know, we used to sell them to employers primarily, and now were selling them to customers. Some of the examples that i mentioned early on is taking the 40 most commonly misunderstood terms, probably something that everyone in this room is familiar with, and recoding those. But also, how to take every single Customer Journey and literally story boarding it out and making it easy and more simplified. This is stuff that ben king, retail hospitality has already done. We are a little behind as a sector. But thats very much the focus of the consumers strategies that the health plans have under way today. I would say, we need to be careful of that, empowering the consumer and not blaming the consumer. So youre absolutely right the information needs to be presented in that understandable way, that plain english way. So that consumers can understand. And i would just add on to that Health Care Professionals really need to be part of this, too. There needs to be more education on how they can communicate clearly to patients. And also need to be thinking about if information is available in other languages as well. And when its translated into those other languages thats also understandable and accessible to people. I think some of this reflects the bumpiness in the shift in strategies. One of the things the Affordable Care act did is for the industry, people are now looking at this directtoconsumer type of channel. Whereas before, they were going to the employers, or to the brokers and agents. And thats a difference. Theres bumpiness in the marketplace and turbulence of the but i think probably what youre hearing is that a lot of the carriers recognize this. Theyre working on it. And theres a lot of really smart marketing. And other people in the system who are probably going to get us back to something thats more plain english accurate reliable, and that consumers can really understand and get their arms around. One more thing. Ill bring it back to the sbc. To the extent that this is out there more and more, and consumers can really build experience with using this, choose the plans and use the coverage, i think it becomes easier. Its an education process. Theyll learn the terms. The glossary we talked about, theres a graphic on the last page that talks about the deductible and outofpocket works. That was enormously helpful to consumers to make those concepts understandable on the way that they havent been before. Okay. Yes . Linda bennett. Im with ask me. And i just want to piggyback on a statement rebecca just made, and joel and others have said about the plain english. But that the demographic now, and in the future, are that there are more limited english proficient, or nonenglish proficient speakers. So beyond translating for the plans, or the sbc, and having good navigators explain when they get that card, and they go to a provider id like to ask natalie, what is anthem and the industry doing to make sure youre in Network Provider has access to the interpreter inperson services they need so that they have good communication, and you have an empowered consumer . And, what are you doing to make sure that there is a system of support . Are you monitoring the electronic records where they say, look, we know this person has limited English Proficiency . They prefer their documents in Something Else . Are there providers providing them with an interpreter . I want to make sure i understand the question. So youre saying, exercise of care where we have limitations or constraints in terms of english speaking, you know, what are the capabilities to ensure that the physician is engaging with the patient . In the language the patient prefers, that they have an interpreter. Part of this is, with the state of washington, for its medicaid program, they have a statewide Interpreter Program where every provider thats medicaid covered can get on and say, next wednesday, i need someone in russian, to speak russian at ten, i need someone in mandarin at 11 00, and somebody in spanish at 3 00. I cant speak to sort of what the health plan is doing specifically in that venue. Im not sure if anyone else can speak to that. I think that Hospital Systems and providers probably have a response to that. Im not entirely sure sort of again, being careful about how the health care interfaces with that relationship. We want to be sure, which i think is where youre going to make it simple and easy. Im not sure im well enough educated on what anthem specifically does in those venues. Yes, maam . My name is airiel zena with the health care coalition. Earlier today, i think rebecca raised that the increased cost sharing the consumers are responsible for making more informed decisions. And providing information and providing clear information on costs and quality. But i wanted to highlight that in april the Kaiser FamilyFoundation Study showed that only 6 of consumers actually looked at price information, and only 2 to 3 actually use that information. I was wondering if in light of that, particularly given that the consumers indicated they dont actually want a real relationship with their health plan, who is really responsible for providing that information and informing consumers . And also when that information is presented in a clear and understandable way, how do we ensure that consumers are actually using it rather than just assuming that they want that, and if its available they will be accessing it . So, yeah, ther