A Healthy New Year

We’re in the midst of a transformational shift in the healthcare industry. Likely you have experienced it yourself, and it’s probably already hit you in the pocketbook. It’s the shift to what is called consumer-directed healthcare.

While on the surface consumer-directed healthcare may seem like nothing more than an attempt by employers to shift some of their spiraling healthcare costs onto their employees, there is much more going on behind the scenes. There is a lot of public policy driving this shift. The general idea is that healthcare costs are out of control because those buying healthcare services traditionally haven’t been the ones paying for them. By shifting healthcare costs to the consumer, the reasoning goes, consumers will demand better value for their money by becoming smart healthcare shoppers, and healthcare costs will begin to decline.

It all makes sense on paper, but there is one huge stumbling block in making this approach work: it’s hard to be a smart shopper when none of the things you are buying have price tags on them.

Data entrepreneurs have already seen this opportunity. Companies like Healthcare Blue Book and ClearCost Health have made real strides, but it’s a big and enormously complicated problem to solve. In part, that’s because hospitals don’t like to disclose their prices and insurers are often contractually prohibited from sharing what they pay specific hospitals for specific procedures.   

 Recognizing the issue, the federal government had mandated that as of January 1 of this year, hospitals must post their pricing for common procedures on their websites in an easily downloadable format.

 There’s a quick opportunity here to put your website scraping tools to work to gather all this pricing data in one place and normalize it. Certainly, there is an analytical product in there somewhere. But it’s less of an opportunity than it seems because what hospitals are generally posting are their list prices – and virtually nobody pays these prices. 

The challenge in hospital pricing is to find out what a specific insurance plan pays a specific hospital for, say, a hip replacement. This could be an ideal opportunity to turn to the crowd.

 One approach might be to aggregate all the pricing data that hospitals are now required to publish and use it as a data backbone – essentially a starting point. Then you could turn to consumers and ask them to anonymously submit their hospital bills and insurance statements. Take those images, use optical character recognition to get them into raw data format, then develop software to extract the valuable pricing data. When specific price data isn’t available, you could back off to list price data that would at least show if a hospital is relatively more or less expensive.

 Obviously it will take a long time to build a comprehensive database consisting of millions of price points, but there are a lot of consumer groups and other constituencies that would be very interested in your success and would work with you to increase the number of bills submitted. Hospitals won’t like this a bit, but as is so often the case, if one group doesn’t want the data out there, you have immediate confirmation that the data are valuable to some other group. Ironically, hospitals submit their price quotes for medical devices to a fascinating data company called MDBuyline to make sure they aren’t over-paying for their purchases.

 Sure, there is lots of complexity hiding under this simple framework. Also, it’s obvious that it will take a long time to build a comprehensive database. But the bromide “don’t let the perfect be the enemy of the good” nicely describes a key to success in the data business. As long as your database is the best available, it doesn’t have to be either complete or perfect. In almost every case, data is so important to decision-making that buyers will take what they can get, warts and all. This is not an invitation to be lazy or sloppy. Rather, it is recognition that you’ll have a marketable product long before you have a complete and perfect product. Just one more reason data is such a great business. Should hospital price data be on your New Year’s resolution list?

Monetizing the Middle

Regular readers know that I am focused (fixated?) on a concept I call “central market position.” I use this term to describe companies (typically media and data companies) that occupy a trusted, established and neutral position in the markets they serve. Central market position is important because it can be monetized.

Traditional data publishers collect data themselves, whether via manual or automated means. They scrub it, organize it and otherwise add value to it, then turn around and sell it This is a solid, established and successful model, but companies with central market position have a much larger opportunity.

With central market position, you have the potential to do things that nobody else can, things that would otherwise be viewed as impossible. You can, for example, ask all the companies in your industry to share their customer lists with you, their sales data, employee information, their prospect lists – practically anything. How is this possible?

Well, two conditions must exist. First, this privileged information will only be provided if it is directly used to solve a major need or problem in the marketplace. Second, the intermediary who will be handling the information has to be established, trusted and neutral. The natural intermediary is a company that has a central market position.

Consider a product called PeerMonitor, a Thomson Reuters product. PeerMonitor literally hooks into the accounting software of participating law firms and sucks out all their billing information, right down to line item detail. Why would any law firm allow this? Because the need to know the going market rate for, say, a bankruptcy attorney in Atlanta far outweighs the reflexive need to protect information like this.

Consider also a company called SQAD in the media world. Advertising agencies electronically submit their purchase orders to SQAD. Are they giving away key company secrets by doing this? Yes, but it’s worth it because the data that comes back to these agencies – namely the real prices being paid for television and radio advertising – is more than worth it. And SQAD, as discussed, is a central, trusted neutral player that normalizes, de-identifies and aggregates the data in such a way that companies can give away their secrets without giving away their secrets. It works for everyone involved. Another interesting company is MDBuyline. Here, participating hospitals submit price quotes for medical devices and other hospital equipment. MDBuyline aggregates the data so that all participating hospitals can see the true going rates for medical equipment, not the meaningless list price. Again, the benefit is sufficiently large to justify supplying confidential information to a third party.

What you need to do is recognize your central market position, and start identifying market needs you can address as the central collector and aggregator of critical industry data that would otherwise never be shared. Trust me, the opportunities are endless.