Lynn Quincy, Director of Health Care Value Hub, Consumers Union

Lynn Quincy, Director of the Health Care Value Hub, Consumers Union

Mark Masselli: This is Conversations on Healthcare, I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, some positive motion f rom a normally stalemated
Congress , the Senate voted to approve $2 billion in additional money for the National
Institute of Health .

Margaret Flinter: Well that’s the second year in a row that Congress has increased
funding to the NIH . They had seen a s teady decline in funding for the past 10 years and
that put a lot of long - term research protocols in jeopardy .

Mark Masselli: Without that funding the US was bound to lose its edge in leading the
world in medical research . It's certainly a step in the right direction Margaret .

Margaret Flinter: Well in addition to $1. 4 billion for Alzheimer's research , another $ 300
million is being earmarked to the President's Precision Medicine Initiative . This seeks to
advance the research of genomics and other emerging disciplines that are going to
make the treatment of disease a more personalized approach , that’s really about
launching medicine into the new frontier , but that’s not going to happen without
cons iderable resources Mark.

Mark Masselli: The cost of healthcare is continuing to rise and increasingly it's
surprising many American health consumers out of accessing necessary care
something our guest today is quite focused in on.

Margaret Flinter: Lyn n Quincy is a long time senior researcher at Consumers Union
that’s the consumer watchdog agency that's focused on ensuring that American
consumers are getting the product s they are paying for , and that those products don’t
cause them harm .

Mark Masselli: Many consumers are finding it increasingly difficult to afford out - of -
pocket cost for healthcare services .

Margaret Flinter: And they are also focus ed on the extremely high rate of medical
errors which leads to an estimated 400,000 deaths per year as we have talked about
other times on the show. Lynn Quincy will be talking about the new venture they have
launched at Consumers Union – the Healthcare Value H ub, that’s aimed to helping
consumers get the best value from their healthcare purch ases and get better care a s
well , so we look forward to that conversation .

Lynn Quincy, Director of the Health Care Value Hub, Consumers Union

Mark Masselli: Lori Robertson stops by, the Managing Editor of FactCheck.org, looks at
misstatements spoken about hea lth policy in the public domain, but no matter what the
topic, you can hear all of our shows by going to chcradio.com.

Margaret Flinter: And as always if you have comments, please email us at
[email protected] or find us on Facebook or Twitter; we love hearing from you. Now
let's get to out interview with Lynn Quincy in just a moment.

Mark Masselli: But first here is our producer Marianne O'Hare with th is week's headline
news.

(Music)

Marianne O'Hare: I am Marianne O'Hare with these healthcare headlines. The Senate
Panel responsible for approving healthcare spending bills has reached a bipartisan
agreement on spending request including $1.4 billion f or Alzheimer's research and $ 300
million for the President's Precision Medicine Initiative , $262 million for the CDC's
Prescription Drug Overdose p rogram also approved as well as money for the Substance
Abuse a nd Mental Health Services Administration . Senate Democrats had asked for
$600 million to confront the crisis which is led to 28 ,000 overdose deaths in 2014 alone .

Meanwhile, while State Health Plans are supposed to cover addiction recovery services
for all customers as an essential benefit , an in dependent analysis of these plans shows
two - thirds of them across the country fall far short . The National Center for Addiction
and Substance Abuse analyzed addiction treatment services required in the 2017
essential health benefits benchmark plans and no ne offered any kind of comprehensive
offerings for addiction service s . The report found the se services were frequently
excluded from overall coverage .

A summer time , that time when you w a nder out - of - doors through nature and find
yourself checking for ticks at the end of the day , it's the ones you miss that cause a big
problems though that [Inaudible 00:03:44 ] New England island of Nantucket is
entertaining and novel approach , 40% of the island's residents have contracted Lyme
disease in re cent years due partially to a large deer population . But an MIT scientist
has crafted an interesting approach , genetically modified mice that are resistant to the
bacteria that causes Lyme infection , mice are further down the tick of food chain but are
vi tal link to the spreading of the disease .

Lynn Quincy, Director of the Health Care Value Hub, Consumers Union

The scientist s proposes testing the release of these mice in a small or uninhabited
island first to see if it works before releasing the genetically altered mice on the main
island the trick will be to find out Ly me resistant gene and breed enough mice with this
trait to scale up the project and the effect . I am Marianne O'Hare with these healthcare
headlines.

(Music)

Mark Masselli: We are speaking today with Lynn Quincy, Director of the Healthcare
Value Hub at Consumers Union , the policy and advocacy organization long time
publisher of Consumer Reports which provides unbiased information on consumer
products including in healthcare Ms. Quincy served as Senior Health Policy Analyst at
Consumer Union testing th e new health insurance disclosure form and tax credit
explainers and advocating for better health insurance literacy strategies . Prior to joining
Consumer Union she was the Senior Researcher at Mathematica Policy Research Inc.
Ms. Quincy also held senior positions with the Institute for Health Policy Solution and
with Watson Wyatt Worldwide . She holds a Masters degree in economics from the
University of Maryland . Lynn, welcome back to Conversations on Healthcare .

Lynn Quincy: I am very pleased to be wi th you.

Mark Masselli: Yeah. It's been four years world has gone by, I mean my God since the
passage of the Affordable Care Act but before the insurance marketplace ’ s plans have
been develop ed you offered some research and analysis to support the creation of
consumer friendly products for consumers to access online as well as to utilize to their
best advantage . And you had four years now together a lot of data in the insurance
marketplaces and I am wondering how those plans lived up to your expectations .

Lynn Quincy: Well I think this mostly a good news story . We ha ve 20 million people
newly insured through the various aspects of Obama Care including Medicaid, the
marketplaces that we are go ing to talk about and allow ing young adults to stay on their
parent ’s coverage. And that’s a huge accomplishment and there have been some
recent stud ies that have conclusively documented the link between having coverage
and having better health . Coming back to the marketplace specifically , we have seen a
lot of progress since the poor launch that frustrated so many consumers and I think it's
still perhaps their dominant impression , for a several years now things have been
working very smoothly. A nd they are also doing a lot , both in the state marketplaces
and the federal marketplaces to make the consumer experience better and make it
easier for them to reliably distinguish from among [PH] plans. They are looking at
increasing the prevalence of so mething called the standard plan design which would

Lynn Quincy, Director of the Health Care Value Hub, Consumers Union

mean cost - sharing wouldn’t vary so much across product s and that would make it
easier to compare different plan s.

Margaret Flinter: Want to talk for a moment about perhaps less exciting element of the
whole issue of insurance for all Americans and that's a new consumer experience
brought to us by the Affordable Care Act the tax forms that consumers now have to file
in order to obtain the subsidies that underwrite the cost of purchasing mandated health
coverage , tell us how that experience i s playing out .

Lynn Quincy: The tax credits are crucial to getting the new coverage , o ver 80% of
those enrolling through the marketplace use these credit s and on average they are
covering three quarters of the premium . So they are really bringing down the cost of
getting insurance coverage , and that’s a huge reason why we have people in insurance
that otherwise wouldn't be . Now, the bad news story is that researchers estimate that
only 5 0% of those who are eligible for the se tax credit s are actually apply ing for them ,
so there's a lot of people there who could be getting a lower - cost insurance coverage
but aren’t for some reason .

Now this is new with Obama Care and it is a tax credit which means you are dealing
with tax forms . Some of the biggest headaches that consumers are facing is that they
have to document their income because you do have to show how much you earn . And
I think what becomes particularly hard is when someon e has an income that’s fluctuates
a lot during the year and it's very hard to predict what their income will be . But on the
whole it is a good news story because they make coverage available to people when it
otherwise might be financially out of reach .

Mark Masselli: Lynn you have taken on a new role at Consumers Union as Director of
the recently launched Healthcare Value Hub , new center that helps advocates and
others address high health care costs , lack of transparency and uneven quality . Health
care costs continue to rise more than we want them to , they have been higher than
people ’s salaries have gone , how do we address multi - trillion dollar question of
controlling the cost of healthcare ?

Lynn Quincy: The issue of healthcare spending that incr eases at a rate that far exceed s
the general rate of economic growth , far exceed s the rate of wage increases , this is a
problem, it's been with us for over 20 years but we haven’t yet systematically as a
nation addressed this issue . And it's past time to do that , and it's a big initiative here at
consumer report s because it is not sustainable and it causes so much financial distress
for both consumer s and businesses and state government crowding out dollars they
need for their other programs . I think that this is an addressable problem but it is a little

Lynn Quincy, Director of the Health Care Value Hub, Consumers Union

bit of a long game, we have a bias in this country to thinking that the marketplace is
going to solve our problem . But when you really , researchers have taken a hard look at
that presumption when it comes to healthcare prices and the market actually do es a
terrible job of pricing things appropriately , of ensuring you have the resources that you
need , of controlling for quality . So we have to I think bring a sort of market and
regulatory appro ach to this problem and we are just beginning to own up to that fact.
But we some work to do in terms of coming tog e ther as a nation to actually enact those
solution s.

Margaret Flinter: Well Lynn one of the areas that you are focused on the Healthcare
V alue Hub is the lack of price transparency and maybe that’s changing somewhat under
the Affordable Care Act, but drug cost something that actually most Americans deal with
regularly as opposed to hospitalization are really crippling consumers in some cases ,
and we have seen this fairly recent but very dramatic trend of just outrageous price
increases for some of the most common dr u g s and what we used to think of as cheap
drugs on the market . Maybe you could talk with us about this lack of price transparency
particularly for pharmaceutical s certainly for ambulatory hospital or diagnostic care a s
well , how are you focus on improving transparency for the consumer in this area and
what can consumers do to get a better value for their dr u g an d other healthcare
purchases ?

Lynn Quincy: So this is a really important question . Price transparency across the
board is a crucial leg of this effort to address high healthcare spending because right
now prices are very opaque, and not just for dr ugs but for everything . We have this
great graphic, we call it the drug price in supply chain and it shows how convoluted in
hitting these various prices are . There is a list price that ’s publicly published but that’s
not the price anybody pay s, we ha ve discounts and other things applied to that price
and then the final price is actually hitting. And there are a lot of efforts around the
country to expose that prices , expose sort of a, do a price justification where not only do
we learn what the true pr ice is but what led to price .

In the case of drugs we had to do that through congressional investigation s, journalistic
investigation and that’s shouldn’t be how we get Information about what the prices are
for our crucial healthcare products that we need . There needs to be a much more
routine and reliable approach to getting to price transparency this is a n important
initiative that’s part of our work on healthcare costs , we are working on that at the state
level and when the opportunity present s itself at the federal level , but I actually think we
will make progress at the state level before the federal .

Lynn Quincy, Director of the Health Care Value Hub, Consumers Union

Mark Masselli: We are speaking to day with Lynn Quincy, D irector of Healthcare Value
Hub at Consumer Union , the policy and advocacy organization , long time publisher of
consumer reports dedicated to providing unbiased information on consumer products
including in healthcare . Lynn I was thinking as you are talking about price transparency
we had Steven Brill on , Margaret a while ago talking about this an d certainly there have
been a lot of advocates but you know I want to talk about another transparency issue
that's truly deadly consequence and a recently released report placed medical mistakes
and errors as the third leading cause of death in this countr y . And we just had Toby
Cosgrove on from the Cleveland Clinic who have really made a concerted effort to be as
transparent on all of these b ut it is a profound problem within the healthcare system .
And you recently filed a report on the scope of the prob lem and your analysis counted
more than 400,000 deaths per year , talk to our listeners about your report and how do
we address this issue of transparency .

Lynn Quincy: It does not be seem to be widely understood that the quality of care
provider by hospitals is actually very uneven. People have a perception that we have
the best healthcare in the world , and sometimes that’s true for certain segments of care
highly technological care that we provide , b ut in other ways it is not true . We have a
graphic that shows the deaths from the hospital acquired infections and that’s just one
type of medical harm exceeds the deaths from drunk driving 7 - 1, and that’s shocking for
people . The report that you reference d is we didn’t do our own assessment of how
often these various forms of medical harm occur , I think the reason that this
conversation doesn’t happen often enough is that people are confused about the
various forms of medical harm s, how is a hospital acquired infection differ ent from a
hospital acquired conditions . And so the report is designed to provide a taxonomy so
we could understand the forms of medical harm s.

We look ed to see what information existed that show ed for each of these types of
medical harm s , how often did they occur , and the big thing about that table is how many
holes there are , and how often we don't know how often medical harm occurs . So for
example , diagnostic errors are very rarely counted , this is hard, we need to do it, we
would like reliable timely data but of course it's not in the hospital’s interests to report it
reliably because they could possibly look bad . And so we need to figure out how to
encourage them to report reliably get the m to correct where corrections are needed
without penalizing them so much that they fail ed to report or they hide these rates of
infections .

Margaret Flinter: Well Lynn, while more Americans have health insurance than ever
before many are still putting o ff accessing health services they really need because the
deductibles on the plans are just so high , and the good news is then of course also that

Lynn Quincy, Director of the Health Care Value Hub, Consumers Union

preventive services are available with regardless of deductibles. And you know
certainly we have seen some o f the most popular plans offered by the insurance
companies are associated with very high out - of - pocket costs or high deductibles , you
are quite concerned about this trend , so perhaps you can share your analysis of this
issue with us.

Lynn Quincy: We really face a crisis in terms of high rates of healthcare spending. And
a huge way in which industry has responded to these cris e s is to make high deductible
health plans more and more prevalent . And these plans are justified by saying t hat , if
we give consumers skin in the game by making them pay out of their own pocket , they
can put pressure on the marketplace . The hope is that they will become these very
smart shoppers and that will put pressure on providers to provide a better value to price
their products competitively and so on . Our report look at across a whole bunch of new
research that shows this is not how it plays out in reality consumers aren’t armed to do
price shopping . And in fact they are often not inclined to pr ice shopping they have other
considerations in mind , the system isn’t set up to allow them to do price shopping and
they are very conf used by cost - sharing and when it applies and when it doesn’t. And
even though these primary preventive care services are free , consumers don't realize
that , and they even cut back when they are face d with the high deductible , they cut back
on high - value services such as that. So it's time to stop placing the burden on
consumer and pretending that they are going to solve a probl em that really should be
solved by other actors in our system . We need to replace high deductible health plans
with more consumer friendly benefits de sign so they do go and get the care they need .
And we need to attack the problem of high prices from the other direction , we need to
go directly to providers , evidence is growing very strong about different new ways of
paying providers to ensure that we get better value from them . So high deductible
health plans overpromise in this time to replace them with something .

Mark Masselli: You know Lynn, consumers out there probably have two things on their
mind s , one is, what are you working on right now that will protect them against
predatory pricing and outcomes but also, what c an they do themselves to ensure they
receive the best value and the best quality care?

Lynn Quincy: We have done a lot of focus group work with consumers and they start
with the assumption that these high healthcare costs is like the weather , there is no thing
they can do about it , b ut there are things we can do about it . So the first thing I would
do is get mad and put pressure on policy makers and regulators to be part of the
solution . One of the first things they should do is try to stay healthy that will make them,
they have better quality of life and reduce their costs , some of the ways they can do that
is by getting the word out about these free preventive services , so there's not

Lynn Quincy, Director of the Health Care Value Hub, Consumers Union

affordability barriers y ou can go and get these preventive servi ces . And if they need
healthcare and they can't afford it, don't put it off so that the problem gets worse , but
instead asked for financial help. If you haven't yet explored the availability of financial
help in terms of getting health coverage through t he exchanges explore that . If you are
seeking hospital care but worried that you won't be able to afford it , a lot of hospital s
ha ve a charity care policies or payment plans and they should always - always ask for
the best deal they can get from the hospita l .

There is things that consumers can do when they are choosing health insurance to get
a consumer friendly plan designs , they can ensure that the drugs they take are covered
by the plan and the providers that they use regularly are in the plane's network , a ll of
those things will help keep their cost down . And finally , if they receive a high bill or an
unexpected bill they should complain to their local insurance regulator , ma n y people
don't realize they have someone in the state that ’s regulates insurance , and we have a
little tool that helps get you to the right regulators in your state.

Margaret Flinter: We have speaking today with Lynn Quincy, Director of the Health c are
Value Hub at Consumers Union , the policy and advocacy arm and long time publisher
of consumer reports . You can learn more and access all of the ir reports by going to
healthcarevaluehub. org and you can follow her on Twitter @ LynnQuincy . Lynn, thank
you so much for the work you do and for joining us on Conversations or Healthc are
today .

Lynn Quincy: I was very pleased to be able to join.

(Music)

Mark Masselli: At Conversations on Healthcare, we want our audience to be truly in the
know when it comes to the facts about healthcare reform and policy. Lori Robertson is
an awa rd - winning journalist and managing editor of FactCheck.org, a nonpartisan,
nonprofit consumer advocate for voters that aim to reduce the level of deception in US
politics. Lori what have you got for us this week?

Lori Robertson: At a congressional hearing, on the impact of environmental regulations
on farming, Rep. Steve King of Iowa underestimated what scientists know about the
relationship between farming practices and water quality. King said, scientists don't
know about the qualit y of water in the US when the Buffalo roamed because there were
no water quality tests then. Pre - 1900 water quality data is relatively scarce, but experts
can use sediment cores from water bodies to evaluate past water quality.

Lynn Quincy, Director of the Health Care Value Hub, Consumers Union

King also implied that this lack of baseline data prevents scientists from knowing
whether applications of crop fertilizer are too much. But experts say they don’t need
19th century data to know fertilizers have negatively impacted water quality. There was
water q uality monitoring in 18 0 0s, for instance chemists developed methods for
evaluating water pollution from sewage and response to outbreaks of cholera and
typhoid fever . And in the late 1800s , Massachusetts carried out what’s been called the
Great Sanitation Survey with more than 40,000 water samples collected . However,
s cientists can use sediment cores from water bodies, to evaluate the water quality of the
past.

In modern times, w ater quality monitoring increased substantially in the 20th century,
especia lly after the Clean Water Act passed in 1972 and m any reports and papers have
concluded that 20th century crop fertilizer use has negatively impacted water quality in
the US . And that’ s my fact check for this week, I am Lori Robertson Managing Editor of
FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players, and is a project of the Annenberg Public Policy Center at th e
University of Pennsylvania. If you have a fact that you would like checked, email us at
chcradio.com. We will have FactCheck.org's Lori Robertson check it out for you here
on Conversations on Healthcare.

(Music)

Margaret Flinter: Each week Conversat ions highlights a bright idea about how to make
wellness a part of our communities and everyday lives. According to the World Health
Organization some 35 million people suffer from some form of dementia and 65 million
people are expected to develop dement ia by the year 2030 with relatively few
treatments available , and still no cure on the horizon. Often when cases become more
advanced , patients are unable to live on their own, they maybe in nursing homes,
maybe sedated . But study show those dementia pat ients who remain more active who
stay outside the clinical setting are more likely to have a much better quality of life , and
that’s the basis for a first of its kind Dementia Village in the Netherlands, built in a small
town outside of Amsterdam. Hogewey an enclosed village built to look and feel exactly
like a normal village but designed to house patients with advanced dementia.

Yvonne van Amerongen: One of the things that are very important to people with
dementia is that they don’t understand what’s happening around them. We try to help
people understand what’s happening .

Margaret Flinter: Co - founder Yvonne van Amerongen says the enclosed village
provides a safe and pleasant environment for them to live where they can walk ,

Lynn Quincy, Director of the Health Care Value Hub, Consumers Union

socialize , remain engage d. The village was built on 4 acres with 23 connected housing
units where patients are group based on their earlier personal lifestyles whether it was
based on interest in the arts or music, academics, gardening . And the director says it
ensures that they maintain social connections.

Yvonne van Amerongen: Those people you live with should be people that could be
your friends, those people probably have the same ideas on life .

Margaret Flinter: Residents are free to walk throughout the compound , there are stores
to shop and restaurants to dine in , a nd the director says relatively no need for excess
medications or restrains that are so commonly used in dementia wards . The village is
neat and orderly , easily navigable and pleasant , a planned and closed residential
community designed to maximize quality of life for dementia patient s , creating a life with
dignity for patients who might ordinarily be institutionalized, sedated or restrained, now
that’s a bright idea.

(Mu sic)

Margaret Flinter: This is Conversations on Healthcare, I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Conversations on Healthcare, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.