ASHTABULA, Ohio — News 5 Investigators are examining one local community’s efforts to lower healthcare costs for its public employees. They’re turning to independent doctors and businesses to help.
This investigation is a part of our commitment to following through, earlier this year we told you how hospitals, by federal regulations, have to show you the prices you’ll pay for procedures and services.
On a busy street in Ashtabula is a medical mile of sorts that has a bunch of health-related businesses on both sides. Among them is the small, independently owned Hoffman’s Pharmacy. That’s where we met up with Ashtabula school teacher Lisa Love.
SCHOOL DISTRICT SEARCHES FOR CHANGE
She told us in 2019, the district saw a big jump in healthcare costs. “Unfortunately, we had a lot of high claims, and being self-insured, it hits you in the pocketbook,” said Love.
Looking to save money, the district didn’t go to the “medical mile” for a solution but rather it veered down a small, dead-end, poorly-patched street in Ashtabula where inside a historic home a man and his team are trying to make history by patching the broken business of healthcare.
“It helps employers take back what health care has kind of been stealing from us all for a long, long time,” said Bryce Heinbaugh who is the CEO of IEN Risk Management Consultants. “It shows employers how to systemically change how health care is purchased and delivered to employees and families.”
USING INDEPENDENT DOCS AND SERVICES
Heinbaugh said he works directly with independent clinics and services, therefore, cutting out healthcare middlemen who have the opportunity to collect big money through fees and non-transparent pricing. “Let’s talk about direct contracts so we know the price before our employees and family members go there,” said Heinbaugh.
The plan offers a nursing service that helps with medical issues plus an independent doctor that’s available on campus for teachers to use during the workday with no out-of-pocket costs or surprises. “He’s not employed by a hospital who tells him how much revenue he has to drive or says you have to order this many services or refer to this many specialists,” Heinbaugh said.
Love has used the accessible doctor when some of her blood work had the wrong coding. “So, I texted him and within five minutes he responded with the correct code and it was fine,” said Love. “So, he’s available 24/7 for free!”
People on the plan can see doctors and use services outside of the no-copay options. It just costs a bit more.
At Hoffman’s Pharmacy, there are no extra charges there. “None of those fees, the pass-through is transparent and available to those like if they wanted to see at any time how much we were charged they can see that,” said Hoffman’s Owner Maria Fowler.
KEEPING MONEY IN THE COMMUNITY
Heinbaugh also told us when big medical systems expand into small towns like what’s happening across the street from Hoffman’s, a large percentage of the money made there goes back to the home base of the hospital. “If our healthcare dollars are being extracted out of the community, there’s less to go around to actually do the social determinants and focus on those things that actually impact people’s outcomes,” he said.
“Saving money, the most money that they can because they can turn around and use that money to make the city better, make the schools better,” said Fowler.
All of this, Love told us, for the same healthcare premiums that teachers were paying before this new Health Rosetta model came on board.
In the last three years, the district reports it has saved a total of $9.5 million. It’s so much money that after the schools saw success Ashtabula city employees like fire, sanitation, and police are now on the same Rosetta plan.
“Let the healthcare control come back to Main Street instead of Wall Street,” said Heinbaugh.
“Every month is zero dollars out of pocket,” said Love.
“And what does that mean to you for spending on other things?” we asked.
“It means on Thursday nights I don’t cook. We go out to dinner,” said Love with a laugh.
Heinbaugh said the plan isn’t just about lower prices. He said they use “centers of excellence” like Mayo Clinic, MD Anderson in Houston, and Johns Hopkins to make sure the quality is there, too, for Ashtabula and many other organizations across the country he works with now.
STRENGTHENING ENFORCEMENT OF PRICING RULES
Since our initial reporting about hospitals posting prices, the Centers for Medicare and Medicaid Services (CMS) just announced changes to the way it enforces the price transparency mandates. For facilities that haven’t made any attempt to comply, CMS won’t issue a warning but will instead ask for a corrective action plan (CAP). Hospitals will have to be compliant within 90 days of receiving a CAP. And there will be automatic monetary penalties now for hospitals that don’t submit a CAP by the deadline or don’t comply within 90 days.
