Test test test test captioning performed by vitac you dont know what else is coming down the pike. I dont want to oversell these tools. They are useful as a way to ballpark things and help consumers shop and compare. Its still a rough estimate because health care by its nature is an unknown in the year ahead. For those planned events and joel spoke about this the huge variation in price with no discernible difference in quality. We know, for example that neck mris will change from 230 to a tenth of that amount. There are certain instances where we can really come very far along in terms of helping people estimate costs and sort of partake in the favorable economics of smart decisionmaking. I had one more thing. Thats just about this whole issue when we talk about the tools for consumers of choice architecture design. Its how we present this information to consumers and theres been studies that consumers will go with the default so really have to think how were presenting the cost information if its based on premiums. Careful thought needs to be put into that. Very good. Thank you. We have a lot of folks lined up. We would ask you to be as brief as you can and stating your question and before you do that identify yourself and your affiliation if you have one. Yes, sir. Go ahead. My name is steven spitz i have two related questions on cost. One, i had an experience in a 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 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 cost. I had at the time a high deductible so it was an important question about my outofpocket cost. The second question is Medicare Part d when i noted it in a biography that 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 still in the law. You want to take that one ed . Why dont you start ill do the first one and second one real quick. The first one was why cant they tell me what the price is. Like i said, forget about the email asking what a price and its like getting trade secrets out of cuba. Its next to impossible. What were seeing is that what the price is and what i owe are two different questions, right . So if i have coverage, i think a lot of plans are really good at estimating costs but sometimes not always. For medicare the vast majority of people have third party coverage. And so it varies what you owe. Theres a bill moving through the house actually in the senate now, that said for medicare, youve got to provide consumers a max outofpocket in across the Hospital Outpatient Department setting the a. M. What tri setting. What we need and will be really exciting, as more data comes into the system, well be able to parse this and cut it and slice it. If youre on medicare this is what youll owe for this procedure at this facility. If youre unshired in the commercial market, this is what youre going to owe. What we see is the price you pay is going to depend on what kind of coverage you do or dont have. This is kind of the first question. The second question is the hhs is prohibited under part d from negotiating drug prices. The private sector is not. The private sector plans pbms and managed Health Insurers aggressively negotiate discounts and 20 to 25 discounts off prescription drugs for seniors. The interesting thing when we enacted that law we talked to cbo about that specific provision. Is it just getting in the middle of these private sector negotiations to get drug discounts versus letting the folks who do this on a daily basis negotiate the discount. 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 law today, what cbo will tell you is it will not save a single dime. The reason is, those pbms and health plans are already negotiating the discounts and they are 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 to that matter anybody else on the panel . You know, its i wouldnt say its common place today, its definitely something that were exploring is in fact the whole inoffice doctors visit and i remarked early on how we dont want to intersecretaryktcretaryintersect that relationship but how do we make decisionmaking tools available at the point of service so that when youre taking out your pad to write a script or comparing different Treatment Options that you have transparency into that today. I wouldnt say its common place. But id certainly say thats where the market would like to move. One caveat though from the consumer perspective, some of this matters to on how the claim is submitted. 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. Cost sharing is how its submitted by the provider and part is how the claim is paid by the carrier. Depending on how all that flows may dictate whether or not you have a copay for the service you may have expected none for. This comes up regularly thats another sort of unknown in the pathway from the care that you receive to the bill that you get. Yes, go right ahead. Im dr. Caroline poplin. To answer the gentlemans question about price price is proprietary information. Every Company Negotiates we different prois with every provider or large provider hospital. So the price is different depending on not just what your plan is but who your insurance is and 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 and i was wondering where that information is where you got it from . The source . Yes, want to make sure this is on. I can share that with you. I think it was it was from a numerous sources but im happy to share that with you. I think it was on my slide its noted. Thats been declining over decades. And still some of the most trusted providers are the Health Care Professionals themselves but weve seen this gradual decline with health plans. And 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. I didnt have there are plenty of publicly available sources and its skepticism with institutions in general but our sector has come under criticism with respect to trust issues i think because theres so much opaqueness around cost and how the whole sector works. And you had another question . A real question something that hasnt been mentioned at all. You assume that people know what they want or theyll recognize did when they see it at least. 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 and know what medications they are taking and know what they need better than a healthy person, for example, it said that women are much more afraid of Breast Cancer than they are of cardiovascular disease but cardiovascular disease is a bigger and more likely threat than Breast Cancer. They dont know what they need, how can they choose it . I would say thats the question were trying to answer. And so, again, everybody is going to have their different take on what they think they might need or what they are most worryied about. Thats why information needs to be presented in various ways so consumers can look at the different whether its Preventative Care or joint replacement. Youre right. They dont know what they dont know. Thats right. And the sensible thing to do then would be to give a comprehensive plan for everybody like apparently they do at the california exchange, that was i think what the gentleman said last week or the week before, that the plans on the exchange were standardized. Standardized to the degree that you can know with a certain set of them you can get a bunch of Services Without having to meet your deductible first. Is that all . Particularly useful you still have the value and general level of generosity and they come with big deductibles as joel was saying. The plan is at 70 , far lower than the employer plan, closer to 80 or 85 or higher maybe. That means you have higher outofpocket costs. I believe in california they said theres a certain set of services you get without meeting your deductible and for a healthy person that would be important who wouldnt otherwise see the value of Health Insurance if they didnt know they do get three primary care doc visits without having to meet a 2,000 deductible. I thought it was much more standardized than that . Do you remember . I think everything but Specialty Drug and high cost things a bunch of things primary care visits, prescription drugs. Okay, thank you. The transcript from the brief sg 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 roe with bmj. Consumers are drowning in choices and options there. One thing the system tried to do was with Preventative Care, limit the package and define it better. We heard today they may not have done that good a job here. My question is primarily is there any rule for simplifying and standardizing what insurers can offer and how they can offer it . Well i just so the value is supposed to be a way to bucket plans in big terms like the relative generosity by level. I touched on this. One of the requirements is there has to be a meaningful difference in the marketplace but that leaves a lot of wiggle room. The kinds of things they are doing in california or other state based marketplaces to limit the number of plans that are products that any given carrier can offer or to standardize them so some set covers the same thing in the same way is one attempt to do that and thats within the authority of the marketplaces. My actual the reason i said wow 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 cancer, they value Different Things in different plans. One of the reasons i think we see i think the Affordable Care act did a good job of saying plans have to do x, y and z. A byproduct of that has been limiting options for plans in order to offer lower prices. Thats why were seeing higher cost sharing in the plans. So i think that to the extent that plans can do a better job explaining the nuances and 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 and other things really going to benefit from precision medicine, probably should go the opposite way on the choice side not further constrict it. Can i just i would also agree with that even though i talked about how consumers can be overwhelmed with choice we do like our choices. And everybody is in a different situation and also their threshold on risk variousries the answer is how do you present those choices. I mean 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 . Yeah, thats correct. And also, its how again 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 that customization, theres been studies done that consumers dont all customize it. How you present it, that default position is really important whether its just showing the premium, showing the deductible, whatever its showing Preventive Services, et cetera. Natalie . Not to pile on, but i think it was perhaps more nuanced in the fact we talk about the para dox of choice and when youre overwhelmed with too many things where you cant distinguish, it adds to frustration. Its about cure ating that set of highly relevant options where its very clear what the difference and tradeoffs are between them. So you know i think its having choices but youve got to know what they are and theyve got to be relevant to you. Yes, sir. My name is ken shaw, with enroll virginia and we help people who are below 400 of federal Poverty Level people with very low Health Insurance literacy. My question to the group is why not work at Insurance Companies reducing complexity and reducing the jargon and trying to educate these consumers on this jargon and trying to get the consumers to learn the program as opposed to changing the program . Yeah. You know, thats precisely what were doing. Were actually going artifact by artifact, 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. We used to sell to employees primarily now selling to customers. One of the examples taking the 40 most commonly misunderstood terms, things that probably everyone in this room is very familiar with, and recoding those. But also, kind of taking every single Customer Journey and story boarding it out and making it easy and more simplified. And this is stuff that banking, retail, hospitality has already done. Were a little behind as a sector but thats very much the focus of the consumer interest strategies that the large health plans have under way today. We need to be careful that were empowering the consumer and not blaming the consumer. Youre absolutely right, that the information needs to be presented in that understandable way, that plain english way. So that consumers can understand. I would add to that Health Care Professionals 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. When its translated into other languages, thats also understandable and assessable to people. I think some of this reflect the bumpyness of the shift in strategies. One of the things the Affordable Care act did, for the industry people are looking at this direct consumer type channel and whereas before they were going to the employers or to the brokers and agents and thats a difference. Theres bumpyness in the marketplace and turbulence. I think what youre hearing that a lot of carriers recognize this and working on it. 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. Im going to 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 to choose plans and use coverage, i think it becomes easier. Its an education process that they learn the terms and how to use benefits. The glossary that ed talked about, theres an info graphic that explains how deductible coinsurance works and we heard that was enormously helpful to consumers to make those concepts understandable in a way that they havent been before. Okay. Yes, go right ahead. Linda bennett, im with afsme. I want to go back to the statement joel and others have said about plain english but that the demographics now and in the future are that there are more limited English Proficient or nonEnglish Proficient speakers as consumers and stake holders. 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 your innetwork providers have access to the interpreter in Person Services they need so that they have good communication and you have an empowered consumer . And what are you doing to make sure thats a system that theres 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. Youre saying sort of at the site of care, will we have limitations or constraints in terms of english speaking, you know, what are the support 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 the state of washington for its medicaid program, they have a statewide Interpreter Program where every provider can thats medicaid covered can get on and say, next wednesday i need someone in russian to speak russian at 10 00. I need someone in mandarin at 11. I need someone in spanish at 3 00