DoctorGlobe, a San Diego-based startup, wants to turn the notion of healthcare price transparency on its head.
The company, which serves members and sponsors of self-insured employer health plans, displays patient out-of-pocket responsibility rather than the price providers bill the employer for. “We actually don’t want to show price to employees, but [rather] show them what’s in it for them,” said DoctorGlobe CEO Tibi Zohar.
DoctorGlobe on Tuesday announced the general release of its system and its first flagship customer: Claim Doc, a six-month-old company which provides claims review and auditing services to self-funded employer groups.
“DoctorGlobe finds and ranks hospitals based upon cost and quality in an employee’s geographic area, offering our member support teams a platform to provide patients with the choice to work within our narrow or primary networks, with out-of-network providers — or both,” Ben Krambeck, CEO of Stuart, Florida-based Claim Doc, said in a statement. “Employers also have the option to choose between a percent of whatever savings the solution creates and a flat fee based on a per-employee-per month charge.”
DoctorGlobe ranks more than 120 types of surgical procedures at about 2,800 U.S. hospitals. A central feature of the system is kind of a private-sector parallel to the Medicare Shared Savings Program. If patients choose a provider from the list DoctorGlobe displays, there is no cost to them. In some cases, patients actually get cash back, splitting the savings the employer realizes from lower-cost providers.
Users can search based on the distance they want to travel, the amount of money they want to pocket or the quality rating of the provider, Zohar explained. Distance and location can make a difference. As the graphics illustrate, the cost of hip or knee replacements are far higher in Southern California (above) than they are in Pittsburgh (below). It may make sense for the patient to fly to another city if the cost is lower and outcome likely to be better.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
DoctorGlobe ranks physicians and hospitals by sheer volume of specific procedures, knowing that high volume usually correlates with better outcomes. It also links users to U.S. News and World Report hospital rankings. “We just selected [U.S. News] because it was the clearest and it had name recognition,” Zohar said.
Data on hospital costs comes from employers, and search results are based on the full price charged to the health plan. “We postpone the reconciliation until the very end,” Zohar said.
The idea is to lower the average all-in price for each procedure. “We can’t win every battle, so we shoot for the majority,” he said.
DoctorGlobe looks at hospital cost more than physician fees because inpatient expenses normally dwarf the physician fee. “[Patients] may get more in bonuses than the reimbursement for the surgeon that performs the operation,” Zohar said.
That’s opposite of how many other transparency engines work. “Don’t start with the surgeon because he or she will tell you what hospital to go to,” based on where that professional has privileges, Zohar explained. “The hospital represents the price. The surgeon represents the quality,” Zohar said.
He compared DoctorGlobe to what Orbitz or Priceline did for the travel industry. “It’s a different methodology.”
The company, which has its development center in Tel Aviv, Israel, has been self-funded since its inception in January 2014. Zohar said DoctorGlobe is in the process of raising its first venture round.
Photo: DoctorGlobe
