For The Record with Shawn Wagoner, Bind On-Demand Health Insurance

October 30  

Shawn Wagoner was on the founding team and leads the Corporate Development, Networks and Sales Teams at Bind On-Demand Health Insurance. Previously Shawn led care coordination company Proximare Health and served on the management team of value based care company Carol Corporation (acquired by Optum). His experience from start-up to Fortune 100 in the insurance industry has been key to the successful launch of the new on-demand health category Bind is building.

Shawn received a B.S. from the United States Military Academy at West Point, and an MBA from Harvard Business School.

How do you define price transparency? 

At Bind, we focus on what people want to know – the exact price they have to pay – and on giving that exact price to them ahead of receiving a service. We find that people are frustrated by most price transparency attempts; they realize that just because a hospital or clinic publishes prices on their website, that does not mean that’s the price they will pay. Costs vary by insurance company, physician, and by your specific care needs during your visit. Price transparency is misleading. It gives consumers false confidence in knowing what they’ll be charged. We believe in cost certainty. Insurance companies are among the only stakeholders that can deliver cost certainty to insured consumers. By analyzing millions of claims, cost to the member can be set in advance of them making a treatment decision. Bind On-Demand Health Insurance is doing this today.

What problem does price transparency address most directly?

Among other data points — like “Will this service help me?” and “Is it safe?” — people want to know the cost of care upfront and have the ability to price-shop and save money. Knowing the cost of care in advance is one major factor they are looking for to help make informed choices that work for their unique circumstances.

Does price transparency help usher in value-based care or does it function independently?

It depends how it’s done. Sadly, prices are not reflective of quality in healthcare today. But they should be. With Bind, lower-cost treatment options reflect more efficient and effective care. Conversely, when a practitioner doesn’t have a pattern of delivering good outcomes, that shows up as a higher cost to members. We are seeing tremendous engagement from various care delivery organizations across the country that believe their organizations will succeed in this type of competitive, transparent market and are eager to help us expand it. 

Can healthcare ever be fully price transparent?

In theory, yes, and at Bind, we feel that we are fairly close to that already. We have taken advantage of advancements in big data and computational power to eliminate the fog around healthcare costs and how much consumers owe. Those advancements alone were not enough, we had to couple them with a better insurance model. Instead of insurance coverage that is one-size-fits-all and pre-purchased during enrollment periods, coverage must be priced in real-time and show consumers treatment and medical practitioner options and their related cost before they get care. With this approach, we can reduce the use of treatments that offer questionable clinical value and increase exposure to harm while at the same time rein in the exorbitant prices that pervade our health system, yet remain hidden to consumers.

Who benefits most from transparent pricing? For whom will it be most disruptive?

Cost certainty benefits people the most; with it, they can make informed choices about their care. This cost certainty, coupled with other important factors like effectiveness and safety, provides people the information they are looking for. As engagement grows with this type of model, the market will get more competitive. Organizations that stand ready to deliver a clear value proposition to the consumer in this market dynamic will win. That does not necessarily mean you have to be the lowest cost option to succeed. Clearly, other service industries see companies with a myriad of value propositions that serve the range of consumers out there from “I only shop on price” to “I do not buy anything without a guarantee or warranty.” On the flip side, cost certainty will be most disruptive to care delivery organizations that operate businesses where their prices are set based on cost-based inputs versus health-based outcomes and health insurance companies that continue to offer and price products based on the utilization that results from this type of care delivery model.

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