Clear Health Costs Founder Jeanne Pinder Seeks to Unmask Healthcare’s High Costs With Online Price Check Tool

Jeanne Pinder – CEO of Clear Health Costs

Female : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter, a show where we speak to the top thought leaders
in health policy, health innovation and technology and the great
minds who are shaping the health care of the future. This week, Mark
and Margaret speak with Jeanne Pinder Founder and CEO of Clear
Health Costs an organization dedicated to helping consumers
understand what stuff cost s in health care. It’s a team of journalists
and every day citizens vetting and sharing the ir health care billing
information around the country , a sort of mashup of Kayak and the
Waze driving a pp to better inform the public about what’s really
behind health costs.

Lori Robertson also checks in, the Managing Editor of FactCheck.org,
looks at mis statement spoken about health policy in the public
domain, separating the fake from the facts . W e end with a bright idea
that's improving health and well being in everyday lives. If you have
comments, please e - mail us at chcradio@chc 1 .com or find us on
Fac ebook or Twitter w e love hearing from you or find us on iTunes,
SoundCloud or ask Alexa to play the progra m Conversations on Health
Care. Now stay tuned for our interview with Jeanne Pinder Founder of
Clear Health Costs on Conversations on Health Care.

Mar k Masselli: We’re speaking today with Jeanne Pinder Founder and CEO of Clear
Health Costs an award - winning web based organization dedicated to
promoting health industry price transparency to help consumers learn
what stuff cost in health care. Prior to tha t she served as an editor
reporter and human service executive at the New York Times, Ms .
Pi nder was selected as a TED resident for the 2018 autumn cohort of
change makers and was named a fellow of the Tow Center for Digital
Journalism at Columbia Universi ty. She earned her degree in Slavic
studies from Indiana University and did advanced work at Leningrad
State University in Russia. She also studied entrepreneurial journalism
at CUNY Graduate School of Journalism. Jeanne, welcome to
Conversations on Health Care .

Jeanne Pinder: Thank you so much for having me.

Mark Masselli: Yeah, I know , it's so exciting. You founded Clear Health Costs in 2011,
after working at the New York Times and you really want ed to
achieve, what seemed difficult to do, making it easie r for consumers
to understand what stuff costs in health care. It seemed that your
strategy was to use the power of journalism to create radical
transparency in health care pricing by building this network of
journalists, committed to investigating the tru e health costs in their
communities. I'm wondering if you could tell our listeners more about
the core mission a t Clear Health Costs and how you attempted to
shine a light on what's driving America's multi trillion dollar health
care system ?

Jeanne Pinder – CEO of Clear Health Costs

Jeanne Pinder: Yeah. Thanks. So, power s of journalism , both on our home site and in
partnership with other news rooms, we're telling people what things
cost in health care. Most people don't realize that the same blood test
could cost $19 one place or $ 522 on other. The same MRI could be
475 one place or $6,221 just a few miles away. Y ou don't know until
months later you get an explanation of benefits that explains exactly
nothing , s o because of the high cost this has generated a huge slow
rolling public health crisis wh ere people feel they can't afford
treatment so they don't get it. We hear this over and over and over
again. People get sick er, they die for lack of treatment. Recent
headlines have spotlighted people who can't afford insulin, but there
are hundreds and th ousands of people facing these choices every day.

Margaret Flinter: Jeanne Clear Health Costs has developed an online tool called
PriceCheck , which you've described , and I love this description as a
mash up of K ayak.com and the Wa ze traffic app for health care , Wa ze
changed my life by the way. G reat that you've included that , and it
aggregates crowd sourced health pricing data from actual health
consumers, which is then verified and supplemented by journalist
who are doing their own price checking. T alk abo ut how media and
other partners contribute to Clear Health Costs pricing framework and
just how does the whole health reporting system work?

Jeanne Pinder: W e built interactive softwar e that very much resembles what we use
on our own site and then we place it on our partner's websites. Makes
it easy for people to both contribute their prices and to search a
database. The database is powered by our initial reporting , as
journalist , w e call hospitals, doctors , clinics and ask them for their
cash prices for co mmon shoppable procedures. 30 or 35 things that
people can actually have discretion over , and t hen we make it really
easy for people to contribute doing what we call crowdsourcing
because insurers do not want to tell us what their negotiated rates
are and because we know that people have a lot of information about
pricing that surpasses our cash knowledge in their filing cabinets , the i r
Google wallets, their credit card statements. W e ask people to join
hands with us and do this kind of journalism. We also do data
journalism and investigative journalism to help reveal the secrets of
health care pricing.

Mark Masselli: Well, speaking of journalism and journalists, we've had a couple of
guests on our show, including your former New York Times' colleague
and au thor Elizabeth Rosenthal as well as Steven Brill, who both
educated and I think illuminated our listeners on how hospital
C hargemasters function. Those behind the scene entities that set
hospital prices in secret , and s urprisingly the Trump A dministration
recently ordered the industry's compliance with the little known
provision of the Affordable Care Act requiring hospitals to make those
C hargemaster s prices available to the public . I’m wonder ing if you

Jeanne Pinder – CEO of Clear Health Costs

could help us understand why this approach to transpa rency though
perhaps well intentioned is inadequate and there also might be a
better approach out there .

Jeanne Pinder: Yeah, so the C h arge masters as you mentioned are the sticker price or
list price only. They're reflected in a sort of medical gobbledygoo k
that is very hard for people to understand. It doesn't use the standard
medical coding system. Only a very few of the ones that I've seen. You
can't really compare from place to place. Plus the list price is generally
really high. If you could actually d ecode it as a patient consumer or as
we like to call them people. You might find out that the price is
unacceptably high and choose not to have that procedure. So what
would be a better solution? Use the coding system uniformly across
all spreadsheets and to require hospitals, doctors, clinics, ambulatory
surgical centers, all the providers to reveal not just the sticker price,
but also what Medicare actually pays, which is a good fixed or
benchmark price in the marketplace. Also the cash rate for that
proc edure. We've heard a lot of people getting a lower cash price
th a n they get on for their insurance. Also we'd like to see the
negotiated rates for the major insurers for each provider and each
procedure that would be Blue Cross , United Healthcare , Cigna, A etna
and any other major provider. That would be true transparency.

Margaret Flinter: Well Jean ne , I think people can probably surmise that trying to price
what a hospital admission would be with all that goes on and all the
variability and some of the un p redictability would be a real challenge
for most consumers in advanced . B ut you say that they have a much
better shot at realizing cost savings when it comes to things like
diagnostic tests or prescription drugs were price s vary widely. Talk
with us about this huge variation and pricing and why sometimes it
may be even cheaper to just pay cash as you were just alluding to a
few moments ago ?

Jeanne Pinder: Right. Well, I’ll start out by telling a story about a woman in New
Orleans who saved $3,786 by shoppin g around. She was prescribed an
MRI by her GP for common hereditary problem that sh e has a
hereditary problem. She scheduled the MRI. The hospital called her
two days before and said, how are you going to pay for this? S he said,
well, how much is it going to cost? T hey said, we ll, what's your
deductible? She said $5,000 but what does that matter? They said,
we'll call your insurance com pany and call you back. They called her
back and said, well, the good news is you've spent part of your
deductible so that MRI is only going to cos t you $4,538 .

Mark Masselli: Oh my God.

Jeanne Pinder: She said, what? She happens to work actually at the Times - Picayune,
which is one of our news partners there. She went over and talk to a
reporter and said, is this possible? Can this be real? He said, well, look

Jeanne Pinder – CEO of Clear Health Costs

in the database and see if you can find the procedure, find the
number, the medical coding number, see if you can find the
procedu re and tell me what you see. She came back and said, I must
be doing something wrong , I fou nd it for $672. 86. H e said, I'm not
sure you're doing anything wrong. We see vari ations like that all the
time, s o she said what should I do? He said, check your work, call your
doc, and if everyth ing looks right go ahead and have it at the less
expensive place, w hich she did saving $3 786. T elling us by the way
that she'd actually pretty much decided that she wasn't going to have
the procedure because it was so expensive.

Incidentally, the less expensive one was also in network provider so i t
did fall again st her deductible. She didn't pay cash. Nobody's taking
care of her except for us. We are the people who were helping her,
which is a really interesting thing i f you think about it . W e're
journalists , w e're not really health care people. Somebody in health
care might be thinking about helping her. The other point that you
made, actually , we have heard a lot of people saying that instead of
paying the negotiated rate, they found that if they ask for a cash
price, they'll pay less s ometimes startlingly less h undreds, even
thousands of dollars less. I t really is important for people to ask in
every case.

Mark Masselli: We're speaking today with Jeanne Pinder , founder and CEO of Clear
Health Costs an award winning web based organization dedicated to
promoting he althcare, price transparency through media and other
indu stry partners to better inform consumers and wh at stuff costs in
health care . P rior to that she served as an e ditor r eporter and h uman
s ervice e xecutive at the New York Times. Jean ne , American
consum ers have become so savvy at shopping online for pretty much
everything they consume except health care. Y our tools provide this
opportunity to really change that. I'm wondering what you think the
cultural bias is out there, around why people are shopping o nline and
making price decis ions everywhere b ut healthcare . I know you're
trying to change that and I think people will behave in that, but have
you out and covered anything about the cultural context that has led
us to somehow, be blinded on anything arou nd cost that relates to
healthcare?

Jeanne Pinder: We think first off, th at most people when they enter the health care
marketplace do not expect to be ripped off or they have their pockets
picked. They expect that prices are going to be somehow uniform or
regulated that their insurance policy and their provider be at a
hospital or doctor are taking care of them and not seeking to just
collect a whole bunch of money. P eople really have this expectation
that good things are going to happen in health care. Th at's starting to
change , because with so many high deductible plans, high co -
insurances, doctors and hospitals out of network, so many more

Jeanne Pinder – CEO of Clear Health Costs

people are exposed to these random pricing variations and they got
you bills, really punishing bills that come along with not asking the
question.

I also think there's a little bit of a stigma or a taboo that may be a
patient doesn't want to ask her doctor because the doctor either
won't know or maybe the doctor feels that he or she is being
somehow unfairly impugned as a money grubber. It's just a very
complicated conversation I think for patients and doctors to have.
What we try to do is to make it easier for that conversation to happen
so that if you're in your doctor's office and she sends you for an MRI,
you can pul l out your handheld and say, you know what, you just sent
me to a place that has a $6, 221 MRI. I have a high deductible plan. Is
it okay if I go to the place that has the $600 MRI ? S o that you can have
a better conversation between patients and providers a bout things
like that .

Margaret Flinter: Well, you know Jeanne we often lay the onus on the government to
fix things or for industry to fix things by perhaps not raking in quite so
much profit on the back of consumers. But in this scenario, I don't
think w e're holding out too much hope for that. Although it did seem
like a step, that the administration was requiring the publishing of the
C hargemaster. But for those of us on the front lines of care delivery as
well as involved in the process of training and educating the next
generation of the healthcare workforce, what are your thoughts on
how we can help clinicians, learn to play perhaps a more active role in
bringing down health cost or in just supporting their patients and
making good decisions about what their recommended treatments
are from a purchasing and cost perspective , a ny thoughts on that?

Jeanne Pinder: Yeah, so we have our handy 10 questions to ask for patients to use
when they're inquiring of providers . W e think that everybody should
get in the habit of asking those questions every time and that it will
become easier. It might be a little bit uncomfortable at the very
beginning, but it has to happen . W e hear a lot from clinicians who are
beginning to take a more active role as they are already r ealizing that
money is a problem and treatment. We hear all the time clinicians
saying, why didn't you take that prescription? Why didn't you get that
treatment? Why did you wind up in the emerging r oom ? W hen the
patient or consumer are really the person a gain, has decided that it's
too hard to talk about money with the d oc. T hey realized that the
prescription that was $40 last month is $500 this month and they're
going to have to choose between medicine or food. It happens over
and over and over again. Doc s in hospitals need to make it easy for
people to ask these questions and to have these conversations and
we hope to facilitate that with our data.

Mark Masselli: Jean ne you a re liking to where -- are now in health care to the former

Jeanne Pinder – CEO of Clear Health Costs

oppressive struggle st rongholds of the Soviet Union. You were there
when the wall came down to o in large part to public pressure. You say
that the American h ealth care s ystem stands at a similar moment and
that it won't be the government but empowered and informed health
consum ers that will help tear down that wall. I'm wondering how you
see that plays out and also do you see that, these new tech enabled
players like Amazon, Apple and Google wil l help advance that in any
way. Walk us through how you see this future of the dissem bling of
the iron grip that the health care industry has on pricing and people’s
behavior will change.

Jeanne Pinder: Yes, I do believe that patients or consumers or people are so angry
and afraid about this, that they are at the breaking point , e mployers
also . That this may unlock the sort of log jam that we see in the
legislative and regulatory function. Our system is damaging the
nation's health , i t's weakening businesses in school districts and
governments . Money goes pouring out of our pockets and our
budgets and into this seemingly unfillable pit of health costs . B ut
people get it , p eople understand now more and more , and I do think
they're about to march on the health care system and on their
legislators and regulators with pitchforks and torches beca use they're
so angry and so upset.

You ask inc onceivably that will result in some kind of legislative or
regulatory action. I don't say that with a great deal of hope in the near
future, but right now change has to come from somewhere. You ask
about Amazon , Apple and Google. I like to think that the salvation is
going to come from there. But truly when you get right down to it,
they're here to make money . W hat we need is fewer people and
entities that are here to make money and more people who want to
solve the problem.

Mark Masselli: P eople just come to a website, is that right?

Jeanne Pinder: Yeah, so we have our home website, which has the interactive
software on it. It has the search tool. We also do a blog explaining to
people things like those 10 quest ions to ask about how to find out
what stuff costs in health care. W e use the blog also to explain, hey,
maybe you get off better by paying cash s o that we ’ re sort of crowd
sourcing the news on this topic as we go forward. T hen we have the
partnerships wit h news organizations nationwide where we do a
larger version of that a deep dive in New Orleans, Philadelphia, San
Francisco, Los Angeles.

Mark Masselli: I'm a journalist. I'm listening into this radio show. What do I do? My
news organization may not be en gaged , do I reach out to you? What
the best pathway?

Jeanne Pinder: Yes, please, [email protected] we're expanding all the

Jeanne Pinder – CEO of Clear Health Costs

time. We're looking for partners and be really happy to talk to
likemin ded people.

Margaret Flinter: We've been speaking today with Jeanne Pinder , Founder and CEO of
Clear Health Costs an award - winning web based organization that's
dedicated to promoting health care price transparency. You can learn
more about their important work and do your own comparison
shopping by going to www.clearhealthcosts.com or follow them on
Twitter @ CH Costs. Jeanne , we want to thank you for your
groundbreaking work, your dedication to improving hea lth care and
access to it and for joining us on Conversations on Health Care today.

Jeanne Pinder: Thank you so much for having me.

[Music]

Mark Masselli: At Conversations on Health Care, we want our audience to be truly in
the know when it comes to the fa cts about health care reform and
policy. Lori Robertson is an award - 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: New York Governor Andrew Cuomo signed the Reproduc tive Health
nd
Act on January 22 the anniversary of the landmark Roe v Wade
Supreme Court decision that guaranteed a woman's right to an
abortion. Readers have sent us a number of questions about the law,
particularly what it means for late term abortions. Let's look at the
facts. The state law permits abortions prior to 24 weeks of the
commencement of pregnancy . After 24 weeks , there are restrictions .
Previously under t he old law , pregnancies after that time could be
terminated only if they were life threatening. The new law provides
for two more instances in w hich abortions would be allowed the
“ absence of fetal viability or to protect the patient's health. ” A
licensed healthcare practitioner must make the determination that
those factors exist.

Roe v Wade held that states may limit abortions after fetal viability
except in cases “ necessary to preserve the life or health of the
mother. ” So New York's old law was inconsis tent with part of the Roe
decision . Under the o ld New York state law, abortions not permitted
under the statute were criminalized, but the new lot removed
abortion from the penal code. The homicide statute, however, defines
a person as “ a human being ” who has been born and is alive . Killing a
baby once born was and is still considered a homicide . As for late
term abortion , states define that in different ways. Some states ban
abortions after 20 weeks. How often are such abortions performed?
The Centers for Disease Control and Prevention says about 1% of
abortions were done after 21 weeks according to 2015 data, and

Jeanne Pinder – CEO of Clear Health Costs

that's my fact check for this week. I'm Lori Robertson, Managing
Editor of FactCheck.org.

[Music]

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 the University of Pennsylvania. If you have a fact that you'd
like checked, e - mail us at www.chcr adio.com . We'll have
FactCheck.org's Lori Robertson check it out for you here on
Conversations on Health Care.

[Music]

Mark Masselli: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Students of
public health are often tasked with devising interventions for
addressing some of health's biggest challenges and for Harvard T . H .
Chan School of Public Health Students, Dan Wexler and Pri y a Patel,
their idea netted a n award and launched a bus iness idea at the same
time. The students were tasked with addressing food insecurity in
underserved parts of the world including a neighborhoods in their
own backyard, families living in high poverty, low resource area a n d
finding fresh, affordable, healt hy food in neighborhoods with no
grocery stores or food markets.

They thought of the current trend of healthy meal or meal services
like Blue Apron and wondered what if we modified that business
model to serve the needs of those living in food deserts . Wex ler and
his partner sourced food delivery companies that could provide
prepackaged meal kits with all ingredients included . I nstead of home
delivery approach, they design refrigerated kiosks that could easily be
placed in local neighborhoods.

Dan Wexler : T here is no delivery system door to door per se and that by setting up
these kiosks in the community you can have a very lean design. You
don't need to pay for shipping, you don't need to have inbox
refrigeration and you are very much addressing the need of access by
physically saying, hey, here is healthy food. It's convenient because
everything you needed in the box. And so just really thinking about
how can we take all those lean design principles to facilitate access
that really, I think making a solutio n that has a potential for impact s .

Mark Masselli: T hey also conducted research with local ethnic groups to create
recipes that would resonate with their families.

Dan Wexler : T hen we just went down to the community and did taste testing at
the Farmer's Ma rket and talk to people and said, do you like this?
What do you want to be able to eat for dinner? B asically we have
some dishes that is similar texture , similar spices.

Jeanne Pinder – CEO of Clear Health Costs

Mark Masselli: Customers can simply walk to the kiosk and purchase their meal kits
wit h the snap cards or cash and they added benefits. The kiosk will be
run by the residents of the neighborhood, giving them an opportunity
to purchase the kiosk and run them like a franchise . A low cost
portable healthy meal service placed in portable kiosk in food desert
neighborhoods, offering families a simple solution to address the
problem of poor nutrition, providing an economic opportunity at the
same time. Now that's a bright idea.

[Music]

Mark Masselli: You've been listening to Conversations on Healt h Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and health.

Female : Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio. com , iTunes, or wherever
you listen to podcasts. If you have comments, please e - mail us at
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