Employer / Employee Health Insurance Issues.

Jim Skinner
Presenter: Neal Howard
Guest: Jim Skinner
Guest Bio: Jim Skinner is the founder and president of the Smart Patient Academy, an insurance benefits enrollment and communications company based in Texas. Its sister company, JMS Benefit Solutions, is an insurance brokerage and consulting firm that works with mid-size employer groups, both domestic and foreign owned

Segment Overview
Jim Skinner discusses Employer / Employee Health Insurance Issues.


Health Professional Radio

Neal Howard: Hello. You’re listening to Health Professional Radio. I’m your host, Neal Howard. Our guest is Jim Skinner. Jim is actually an insurance broker. He is now an author as well. How are you doing, Jim?

Jim Skinner: Pretty well.

Neal: You did say that there is financial skin in the game.  With the new health care law, consumers have a whole lot more financial skin in the game as opposed to a few years ago, especially when it comes to employee/employer insurance plans.  Could you speak to that just a bit?

Jim: Yeah.  I think we had talked about the article that came out in the Wall Street Journal December that talked about a big cost shift and risk shift from employers to employees and just in the general health plans that are offered on the exchanges.  So what’s going on is you’re absolutely correct.  There are out-of-pocket expenses, and there are risks out there that most people are unaware of.  That’s part of why we’re talking today, is just to try and make people aware of their exposure.

For example, on a silver plan… or on most of these plans that you’ll see on the exchanges, there’s a maximum out-of-pocket of $6,350.  Well, relative to a $100,000 bill, $6,350 is not a lot of money.  But if you’re not expecting $6,300 somewhere in 2014, you may want to recalibrate your savings a little bit and also learn how to avoid deductible-related expenses when you can.  I’m sure this triggers a whole series of other questions, but–

Neal: Yes, yes.  Now, when you’re talking about navigating prices and being aware of prices, the prices aren’t fixed?  You can get open heart surgery cheaper at one facility as opposed to another, or one doctor as opposed to another?  Or cancer treatment.  You went through a year of intense invasive cancer treatment, and it hit you in the pocket extremely hard.  How do you reconcile this massive financial burden that’s been thrust upon us and still not be afraid to ask or negotiate?

Jim: Right.  That’s a good question.  One thing that people need to be aware of is right off the bat, is that there’s a 300 to 500 per cent pricing differentials for exactly the same medical procedure of the same quality ordered by the same doctor in the same network in the same zip code.

Neal: Okay, 300 different pricing … ?

Jim: Three hundred to 500 per cent pricing differential.

Neal: That’s crazy.

Jim: It’s absolutely crazy.  This is kind of good news in the sense that one of the few things that Obamacare did that I like, is that there’s a thing called the HITECH Act that was buried in this 2,200 pages of law that required the disclosure of prices by providers, mostly hospitals, who had heretofore had this as proprietary business information.  Now they’re disclosing prices, and these insurance geeks, if you will, out in Silicon Valley, have created all of these algorithms and computer-driven ways to figure out where the best prices are for exactly the same procedures.

They’ve created companies that are called price transparency companies that go out and do this as a concierge level type service, in most cases, to groups.  This can be bought individually, but in groups … to give you an idea, there’s a company out of Dallas called Compass, and this is all they do.  As an example, let’s say they say, “Hey, Neal.  You need an MRI of your brain.”

You call up Compass and you say, “Okay, I’ve got the following procedure code.  Can you please go shop this for me?”  What they’ll do is they’ll come back with a report in 24 hours with location A, location B, location C, all with qualitative indicators and prices anywhere from 300 to 500 per cent different.  They don’t tell you who to choose.  You’re going to redirect your care to the best value, the highest quality at the lowest price.

Neal: Now, these companies sprang up as a result of the Affordable Care Act, or were they already in existence, just at a lower level of activity?

Jim: I know that they were gearing up once they saw the legislation developing in 2009, say.  Because we had Obamacare pass in 2010.  By the time 2010 came around, you started to see more and more of these companies.  But I think that they knew what was coming down the pike.  For those people that don’t want to buy a service, there’s been a longstanding website that is calledthehealthcarebluebook.com, and it’s a take-off from the Kelley Blue Book, where you go shop out the price of your used car.

In other words, it will give you a value for a used car.  People are familiar with that.  So it’s thehealthcarebluebook.com.  It’s a completely free service, and it will tell you exactly what an endoscopy costs in a 78130 zip code on a certain date.  It’s a really cool process.

Neal: That’s just like airline prices, the concierge services with airlines and hotels.  Now, you’re also an author.  Your book, Smart Patient, Smart Money, is doing well, and it’s giving consumers and other health care professionals a tool with which they can educate their patients and themselves as well, yes?

Jim: Yeah, absolutely.  It’s Smart Patient, Smart Money: The Essential Playbook for the New Health Care Consumer.  The words I picked to title it are kind of very intentional.  The “smart patient” goes to how do you extract value out of this health care system.  It’s not just about money.  As a matter of fact, our industry in the insurance industry, I kind of chide the industry quite a bit about talking about money all the time when we really need to be talking about impact. 

The impact on people’s lives is what you and I started this conversation about with talking about getting cancer and surviving it and getting through the system.  So being an expert patient is a skill set, and so we’re sharing how to do that.  At the same time, we’re sharing with people how to manage their money in this process and not go broke.  Then finally, the piece about being a new health care consumers is a reference to what I call a new health care marketplace.  So we really need to adopt a new health care… a consumer mindset to adapt to this new marketplace.

Neal: Great, great.  That’s some great information.  Your book, Smart Patient, Smart Money: The Essential Playbook for the New Health Care Consumer, is available on Amazon.  Is it also available at your website?

Jim: Yeah, it is.  It’s at smartpatientacademy.com.  It’s available right there, and there are also links to the Barnes & Noble website as well as it’s on iTunes.  There’s an ebook version of it too, Kindle book.

Neal: Great.  You’ve been listening to Health Professional Radio.  I’m your host, Neal Howard.  Our guest in studio this afternoon has been Jim Skinner.  He’s a health insurance broker and an expert in health care insurance talking about health care reform.  It’s been great having you here with us today, Jim.

Jim: Thank you.

Neal: Transcripts of this program are available at healthprofessionalradio.com.au and also at hpr.fm.

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