About the Episode
Are you tired of unexpected medical bills? Do you wish you knew the cost of healthcare before your appointment? You're not alone. On this episode of HealthTech Remedy, radiation oncologists Dr. Trevor Royce and Dr. Timothy Showalter dive deep into the confusing world of healthcare price transparency.
We discuss the age-old problem in the U.S. healthcare system: opaque pricing where even providers don't always know what procedures cost. We explore how recent legislation, like the Hospital Price Transparency rule (requiring hospitals to publish charges in machine-readable files), the No Surprises Act (protecting against surprise out-of-network bills), and the Transparency in Coverage rule (involving payers), are pushing the industry towards greater openness.
Joining us is Carol Skenes, VP of Product at Turquoise Health. Carol shares her journey from healthcare consulting into the world of price transparency. She explains how Turquoise Health has positioned itself as a neutral third party and meeting place, aggregating massive amounts of data from hospital and payer machine-readable files (MRFs). Turquoise parses and cleans this previously guarded information to remove noise and extract meaningful negotiated rates.
Learn how Turquoise Health provides solutions for hospitals, payers, and employers, helping them understand market rates for negotiation and cost-effective care planning. Ultimately, their North Star is empowering patients to know their costs beforehand, price shop, and avoid unexpected bills. While patient-facing tools are still developing, tied to regulatory requirements like Good Faith Estimates, the foundation is being built on this aggregated data.
We also touch on the challenges of getting hospitals to comply with transparency rules and how Turquoise Health helps bridge that gap. Discover why price transparency is gaining bipartisan support and how Turquoise is influencing legislation and making a real impact.
Hear Carol's advice for those wanting to make an impact in this crucial space: be a student of the industry and trust your instincts.
Tune in to understand how Turquoise Health is navigating the complex landscape of healthcare pricing and working towards a more transparent, competitive market.
Note: Our beloved co-host Paul Gerard is missing in action this episode, off making "poor life choices" like a conference call!
Transcript
Dr. Trevor Royce:
[0:00] Tim, it's good to see you.
Dr. Timothy Showalter:
[0:01] Hey, Trevor. Good morning.
Dr. Trevor Royce:
[0:02] It is spring in Charlottesville, Virginia. There is nothing better. What's your top three? Charlottesville spring.
Dr. Timothy Showalter:
[0:08] I love getting out to get a meal outside. You know, I'm a layer guy. I'm a sweater weather guy. I love the morning starting off that way. And then I like planning to go hiking, but it doesn't always happen. But, you know, just like I like to view myself as an outdoorsy guy. So, fantastic. How about you? What are you up to? Are you just chasing kids around in it?
Dr. Trevor Royce:
[0:27] Well, if I was in Charlottesville, I'd be going to Foxwood horse races for sure. But maybe I've outgrown that.
Dr. Timothy Showalter:
[0:32] I think you're too old for that, man.
Dr. Trevor Royce:
[0:34] All right, let's dive in.
Dr. Timothy Showalter:
[0:35] Paul would usually say, let's drop the hammer or something, but I guess we can just be respectful about it.
Dr. Trevor Royce:
[0:39] We can't replace Paul.
Dr. Timothy Showalter:
[0:40] We can't replace. Let's hop in, man.
Dr. Trevor Royce:
[0:44] Welcome to Health Tech Remedy, the show where three physician leaders in health technology tell the stories of new and established companies and interview leaders from the industry. I'm Trevor Royce, radiation oncologist and researcher with experience in real-world evidence, informatics, and AI diagnostics.
Dr. Timothy Showalter:
[0:57] I'm Tim Showalter, a radiation oncologist and prior medical device entrepreneur who is now focused on bringing AI advances to cancer patients. Missing in action today is our beloved co-host, the third side of our isosceles triangle of health tech remedy, Paul Gerard. He started off as a physical medicine and rehabilitation specialist before focusing on reimbursement policy, molecular diagnostics, and market access for AI products. Despite being a great guy, he sometimes makes poor life choices for priorities and chose to hop on some conference call or something instead of joining us here today. So we'll have to do our best, Trevor, to keep the conversation going.
Dr. Trevor Royce:
[1:36] I think we can try. We can try. We can't replace Paul, but we're going to try today.
Dr. Timothy Showalter:
[1:40] Yeah, we'll do our best. We won't talk about watches or craft beer for Maine today. So listeners should dial in for another episode in the future if they really want that.
Dr. Trevor Royce:
[1:50] We should have a standalone craft beer episode where Paul can really just shine.
Dr. Timothy Showalter:
[1:55] We could just hang out enjoy the beer. All right, kick us off. What are we talking about today?
Dr. Trevor Royce:
[2:00] All right, today we've got a good one. I'm personally excited about this. This is a topic kind of near and dear to my heart. Turquoise Health, they are a health technology company that has built a platform to provide price transparency to healthcare. So they're a neutral third party in the healthcare ecosystem, and they've positioned themselves as a meeting place for transparent relationships in pricing. And then later, we're going to speak to Carol Skeens, VP of product at Turquoise Health. We can talk a little bit on this issue of price transparency, but maybe before we dive into that, Tim, tell us a little bit about Turquoise and how they came to be.
Dr. Timothy Showalter:
[2:32] Well, you know, I think a lot of what they were focused on for the sort of the genesis is if you've experienced the lack of price transparency as a patient or as a family member, you know how confusing it is. So like understanding that the cost of your MRI, you know, for your mid 40s weekend warrior knee injury can vary wildly from hospital to hospital and from practice environment to practice environment. Is it hospital-based or is it, or is it, you know, freestanding clinic? And, you know, you and I both know this. I've had patients ask me, like, how much will this course of radiation cost me? And it's weird. It's like, we don't know, you know, and you can, you can get an analysis or a prediction, but sometimes it's off of comparing ultimately the patients out of pocket, what their insurance company paid, like using a sample patient previously treated. It's not like there's a menu of prices. And I think overall, you know, Turquoise came on board where the policy pressure really melted over time. And we could talk a little bit about what, you know, what the legislation was. I think there's a few ones to cover. But I think the general sense is this is a problem that needed to be solved in the time was like now to solve it. And, you know, you and I, I think we have a great colleague from Flatiron when we were there, Forrest, who joined there. And, you know, he's a smart guy and is driven by mission. And you always know he'll be up to something good.
Dr. Timothy Showalter:
[3:55] So that honestly, that's how I first heard about Turquoise. And what I've learned since then has been has been really impressive. They really established themselves as a thought leader. They've published, you know, academic and sort of what policy informing research. And it's pretty impressive. And they've got their own sort of learning university online for folks who want to learn more about these topics. And so they've really established themselves as sort of the epicenter of this conversation.
Dr. Trevor Royce:
[4:22] Very cool. Yeah, I actually was not aware that they had a, educational component on their website. So I'll have to check that out.
Dr. Timothy Showalter:
[4:27] Yeah, it's called TQU. I think TQ is for Turquoise. We can also ask Carol that too.
Dr. Trevor Royce:
[4:33] Yeah, it's, I mean, I think the educational component is so important in this because, you know, we know experiencing it day to day as providers, like the relationship between who is delivering a service or recommending a service, you know, the provider or caregiver is so far from the recipient or the patient in terms of the costs and the costs involved and how, you know funds are being transferred and all that because you have the payer in the middle and so you know not only do we not know how much things cost but the recipient or the patient isn't also doesn't know how much they cost and in fact you could even argue not to be nihilistic but do we even care what the cost is and and the system is in part set up to not care because you have a payer that's thinking about that and and taking care of those costs and at any rate the the system is set up the way it is but a consequence of that is that no one really has any idea how much things cost or who's getting paid for what. And the entire process has been totally opaque. And so there's been some legislation that was introduced that basically was forcing healthcare systems to post prices. And the prices are different from the costs. You know, a contract with a payer for a service could be different from what a hospital says that they list that service costs. And so part of what Turquoise is doing, or at least my understanding, is being an aggregator for that data that now is publicly available, putting it all in one space so everyone can see how much how much things cost. And it'll be awesome to hear from Carol kind of what they've been able to accomplish to date, but also what some of the challenges are in getting that pricing data.
Dr. Timothy Showalter:
[5:58] Obviously, this is an age old problem as a couple like health care natives. You know, there's an element where with the U.S. health care system, it's a little embarrassing. It's taken this long to have a Turquoise Health. But, you know, maybe you want to just share with our listeners what their sort of their founding timeline and story is.
Dr. Trevor Royce:
[6:14] Yeah. So their timing coincided with a lot of this transparency legislation. So they were co-founded in 2020 by Chris Severn, who is the CEO, and Adam Geitke, who is the chief technical officer. They had a Series A for $20 million in 2022, led by Andreessen Horowitz, with participation from Bessemer Venture Partners, Box Group, and Tiger Global. So some sort of big name venture backers here. And then in January of 2024, last year, they had a Series B. They raised $30 million, led by Adam Street Partners, with participation from Yosemite and some existing investors. And basically, the goal of that Series B was to support these further transparency pricing efforts across a customer base, I think, of over 160 healthcare organizations. And with that, in April of 2024, they acquired Bramble Health, which was basically a management platform to empower primary care providers and regional health plans to basically understand their networks and unlock those networks and become a more transparent marketplace. The founder of Bramble was Molly Moore, who also joined the Turquoise Health team. And we'll hear more about this from Carol.
Dr. Timothy Showalter:
[7:18] It's interesting for this story because this is like a deep technical team. Like the founders are very strong technically, but they also had prior experience within health care, like revenue cycle management and understanding of the payer landscape. So I think, you know, my sense is they had, you know, sort of earned their stripes, so to speak, within within health care and yet have like really strong technical background. And honestly, you know, it's probably a really challenging technical problem. And I don't really have my head wrapped around how they pull all the data together. You know, the way the legislation went down, like there is some expectation that the data provided by hospitals can be ingested in a sort of technology stack and a machine readable format.
Dr. Trevor Royce:
[7:59] A critical one to be aware of is this hospital price transparency rule, which really came into play effectively January 1st of 2021. So right around when Turquoise Health was coming on scene, I think that's not accidental. And basically, this was a really keystone moment in price transparency for health care, where CMS, you know, the largest payer in the U.S., was requiring hospitals to publish some of their charges. And so this required, to your point, a machine-readable file, so some sort of ingestible format, containing gross charges, discounted cash prices, payer-specific negotiated charges, de-identified minimum and maximum negotiated charges. And they had listed 300 sort of shoppable services that a hospital must provide and post on their website with some kind of consumer-friendly display with a description of the services and the prices for each service and so forth.
Dr. Trevor Royce:
[8:51] So just to give an example, you know, you could want to know how much a CT scan of your chest costs and you could actually go on the hospital website for the first time as mandated by CMS. You know, if you and we could talk a little bit more about what kind of penalties may exist if you didn't post this. But basically the spirit of it was to have hospitals post these prices and then presumably patients could look around or providers could look around and basically compare introduce a more competitive market in a very non-competitive healthcare environment to try to bring some of these prices down as we know the prices in healthcare across the U.S. have just exploded over the last 20 years to the point where it's a major part of the GDP is goes towards healthcare.
Dr. Timothy Showalter:
[9:30] My sense is that like this is it sounds obvious you know like if you go to you know Ben and Jerry's, and you want to get ice cream, you know what the prices are. My sense is that hospitals really are generally not set up for this. So my understanding from reading what I could about Turquoise is that part of their pitch for hospitals and providers is to actually help them get that information on the website and help them understand what a price should be, get a sense of the competitive landscape, and to help them put it into machine-readable files. But my understanding as a consumer and provider who's like sort of clicked around some of his websites is that people haven't done that well with this. So I think we definitely need an entity like Turquoise to help push this along.
Dr. Trevor Royce:
[10:13] It might be useful to spend just a couple of moments speaking specifics, what this actually looks like. And just to illustrate that, as a researcher, you know, when I was full-time academics doing health services type research and health policy research, there was a lot of excitement when this price transference rule went into effect and all these prices were suddenly going to be available online. And so what we did was look at how much a course of radiation for prostate cancer would cost amongst a bunch of different cancer centers that were now required to post these prices. And it was very quickly obvious, number one, how big of a mess it is implementing this, like in terms of adherence, something like 80% or even maybe even less than that of the hospitals actually were complying and listing their prices. And then the prices listed were so widely variable. I mean, for a course of radiation, we saw charges for, say, a 28-course treatment of prostate radiation from $20,000 to $400,000. So it's really hard, you know, can imagine as a patient with prostate cancer how to make heads or tails of this. If you could even find where the prices are listed on websites and why there's such, like, wild discrepancies between the costs.
Dr. Timothy Showalter:
[11:15] Which connects with the next thing because basically you can't surprise patients.
Dr. Trevor Royce:
[11:19] Right, right. To your point, you know, there have been some subsequent legislations like the No Surprises Act, which protects patients basically from unexpected out-of-network bills. And a lot of this relates to like emergency room visits or anesthesiologists or radiologists where you may be seen at a hospital, but some of those providers may belong to a different network and could charge differently. There are all sorts of weird consequences of that where you could get these massive bills for seemingly routine care at hospitals.
Dr. Timothy Showalter:
[11:44] It's terrifying. It's like the last thing you just have to think about.
Dr. Trevor Royce:
[11:47] Yeah, yeah. And then there was the transparency and coverage rule. I'm less familiar with this one, but that was started in 2022, basically subsequent iterations of this. Of these transparency efforts. You know, one challenge with these transparency efforts has been adherence from the, hospitals side. And so there have been all sorts of penalties that have been introduced over the years of sort of increasing severity, you know, cash penalties against hospitals that are not posting their prices transparently.
Dr. Timothy Showalter:
[12:16] Yeah. And my understanding of the transparency coverage rule, I'm no expert, this is where we missed Paul, but my understanding is it's sort of like this pulls the group health plans and the health insurers into it. So, you know, it's the The idea is that it would help the beneficiaries to understand, you know, given a set of services, what can they expect to pay? And it should potentially work with both negotiated rates within network providers as well as, you know, what's happened in the past with out-of-network providers. And there's some responsibility to make sure it's available by an internet browser. We can talk a little bit about the Turquoise platform. You know, they've got a lot of solutions for each of the stakeholders. So I just briefly sort of menu them off a little bit and maybe we can go deep on a few of these with Carol. So one is that they have a solution for clear rates data. I think this is just directly solved the need to post data on each hospital's site about prices for services. Analytics to help the payers and hospitals have benchmarks for what the rates are generally in the market and what makes sense. They have a solution to have clear contract information. And so this helps payers and hospitals to have all of their agreements, you know, because they may have hundreds of agreements for different services or with different payers. And so the idea is to leverage AI and technology solutions to reduce the administrative burden so they can actually access their own information.
Dr. Timothy Showalter:
[13:41] There's a search functions, which helps patients who are members of our participating health plans to search care and find pricing for services. So, for example, if you're going to get a colonoscopy, you can enter your insurance plan information and find providers nearby and get a sense of your cost. This checks a lot of compliance boxes overall for the hospitals. So they, you know, I think Turquoise helps hospitals get their machine readable files in order and get access to information to plan their business objectives. They can enable good faith estimates provided directly to patients. And then I think they can set their custom rates for various services using benchmark data. And then the other thing that I think is really helpful getting back to the alternative payment model is a potential for what they call standard service packages. So all this information could be used to create a single bundle package. And I think this is important for hospitals to offer these sort of marketplace type services. And it's really important for if you're a patient. Or even, I would imagine, a payer to understand, like, what's all in for that service? So I think that's a really, like, key tool. They can pull in several billing codes and create, like, one package service.
Dr. Trevor Royce:
[14:53] Amazing. Yeah, so they've really inserted themselves in the middle of this transparency conversation with some really unique products available. And I am personally very excited to hear from Carol about kind of how they where they see this transparency effort going and how they can have a business around it and also advance sort of value value based care in the U.S. through it.
Dr. Timothy Showalter:
[15:15] Things I want to sort of touch on is I really don't understand exactly how they make money. So I'd like to understand that. Like what what are their big customers? I certainly know they make an impact. I think there's something there. And I'm also curious with the new administration, if there are significant changes that they're watching out for. So it'd be interesting to touch on that with her as well. Trevor, before we meet with Carol, I'll just also mention to you that she is a graduate of Georgia Tech. So there's some ACC connections. And then the other thing is she does have deep experience in price transparency work. So it'll be interesting to get her perspective on sort of what Turquoise has done and where they're heading.
Dr. Trevor Royce:
[15:56] Fantastic. Looking forward to chatting with Carol soon.
Dr. Timothy Showalter:
[16:01] Carol, welcome to the show.
Carol Skenes:
[16:02] Hi, good morning. Thanks for having me.
Dr. Timothy Showalter:
[16:04] Where do we find you today for this interview?
Carol Skenes:
[16:06] You find me in sunny Charleston, South Carolina.
Dr. Timothy Showalter:
[16:09] We are all envious of that. Trevor and I are in Virginia and North Carolina, respectively. But I think you win right now.
Carol Skenes:
[16:16] As long as it's not a hurricane, you know, then all we have to complain about is pollen otherwise.
Dr. Timothy Showalter:
[16:21] Lighter detail, yeah. Well, you know, we're excited to learn more about Turquoise Health. But before we hop into that, you know, we were hoping to learn a little bit more about your own career journey and maybe starting with your your educational background and then how you came to focus in health care and then more specifically Turquoise Health.
Carol Skenes:
[16:39] I went to undergrad at Georgia Tech and was on an operations specific track. And there was one elective that I took my junior year called Management of Health Care Operations. And I live for the day that someone asks me, where were you when you first learned what a DRG was? No one has asked me yet, but it would be in that class. And it was the first time that I'd ever considered there was a whole business administrative side to health care. It was at the time kind of understood that you could either be a clinician or you'd go on and do other things. And I really enjoyed thinking about business. I enjoyed thinking about these massive problems that were going to take a bunch of smart people to solve in health care. And I was coming off of a summer internship where I worked at an oral surgeon's office in my hometown, just, you know, doing little things here and there, learning about billing, kind of learning about the process of keeping the lights on at a clinician's office. And it really stuck with me from there. And so that class and that experience had me choosing to start my career once I graduated in healthcare consulting. I spent a good chunk of time working in revenue cycle consulting, understanding managed care contracts, the relationships between healthcare providers and insurers, And then eventually I pivoted into the startup world, first doing revenue cycle automation, and now where I am at Turquoise focused on price transparency.
Dr. Timothy Showalter:
[18:03] Well, kudos to you for figuring out what a DRG is so early. I will say that Trevor and I are both physicians, and you probably have a higher level of understanding about it than I do even now after practicing for so many years. I was going to make a prostate cancer joke about where I was when I first figured out what a DRE was, but then I figured that would be too classless. So I'm glad that glad that we avoided that.
Carol Skenes:
[18:25] No, someone in our listening audience is laughing right now, I promise.
Dr. Trevor Royce:
[18:29] Yeah, I think I think you're in a rare subset on this call that can tell the difference between a DRG and a DRE.
Dr. Timothy Showalter:
[18:35] So we're doing all right today. Exactly. Well, I guess, you know, I think it's a really helpful background. And it does explain a lot about transitioning from like a really strong technical background into the health care reimbursement space. And we certainly need people like you who have like deep experience and deep understanding of the landscape, like even more than the average physician taking on these problems. And I'd be curious to hear sort of in your words, like how would you describe Turquoise Health's business? Like if you're talking to a lay person or, you know, a stupid radiation oncologist like me, like how would you describe the business?
Carol Skenes:
[19:10] When I first joined Turquoise and people asked what I did, I just said that I worked at a startup. And then if they took it one step further, they asked specifically, what did I do at the startup? Honestly, I just said data modeling. That had nothing to do with what I did, but it just felt like the easiest answer, sort of what a stereotypical startup employee would do. I have since graduated from just saying that I work in data modeling. And now particularly that there's more awareness of this concept of price transparency. Usually what I tell them is that we're working to make prices more transparent for patients as consumers and also for stakeholders in the industry. And honestly, that's usually about as far as I get into me doing the talking, because as soon as you mention something related to price transparency, usually whoever it is you're talking to either has a question about a bill they've received recently. Well, you work in price transparency. Do you know anything about XYZ authorization or denial? Or they share a story about a bill they've received or someone in their family has received that they were not expecting, you know, is higher than they anticipated. So it ends up being a conversation that hits close to home for a lot of people. They internalize what we do based on their own experiences interacting with this healthcare system.
Dr. Timothy Showalter:
[20:24] I bet. I think we've all got our stories about trying to figure out what something costs or trying to tell a patient what something costs and it's really challenging.
Carol Skenes:
[20:31] Agreed. I know. I think it's one of those things where if you were to ask any person what do you think needs to improve on the administrative side or the business side of healthcare, it's one of those moments where it's like, well, how much time do you have? You know, let's go get a coffee. Let me tell you about all of these things that I've experienced or people around me have experienced. So it is very personal in that way, but it is also a massive macro problem that we're trying to solve.
Dr. Trevor Royce:
[20:54] And can you reflect a little bit on kind of how far we've come on price transparency and, you know, how far we have to go still and related to that kind of how Turquoise is getting these data, you know, how things are integrated, how do you interact or integrate with providers, hospitals, payers? Describe to us how Turquoise sits in the middle of all this and how that's possible.
Carol Skenes:
[21:15] So for those who don't know as much about the price transparency legislation, in terms of how far we've come, it was on January 1st of 2021 that we first got access to what is known in the industry as machine-readable files, or MRFs.
Carol Skenes:
[21:29] And contained in those MRFs that first came specifically from hospitals were a number of data points related to gross charges and self-pay, cash prices, but also specifically payer negotiated rates that were the negotiated rate, let's say, between an Aetna or a Cigna.
Carol Skenes:
[21:48] Or a Blue Cross between that insurance company and the specific hospital. And those negotiated rates prior to 2021 were guarded under lock and key. There were very few people who knew what the rates were. It was sort of viewed as a competitive or a negotiating tactic to keep your rates to yourself if you worked for a hospital. But as we know, if you have insurance or percent co-insurance or the ability to hit your deductible, your out-of-pocket max, a lot of that is predicated on understanding what that negotiated rate is. So in terms of how far we've come, when the machine-readable files first came out from hospitals in 2021, and then in July of 2022, payers were also required to publish their own rates, the glut of information that became available over that 18-month period of time ushered us into this new industry pretty quickly, right? Previously, we were an industry that didn't know these rates. Now, not only does the industry know them. They are free and publicly available to go download. Now there's some size constraints and a number of people have said they tried to download a payer machine readable file. It promptly crashed their computer, but they're not behind paywalls that they are available for public consumption for innovators to parse them.
Carol Skenes:
[23:05] Look for trends and so on. So when I think specifically about the concept of price transparency, in my mind, there's this pre-MRF world, and now we're in this post-MRF world. So what we do is aggregate data from a couple of different sources, those hospital machine-readable files, the payer machine-readable files. We also pull claims data, some Medicare reference data that is publicly available. And the reason we pull each of these different data sources and aggregate them together into one platform experience is because I think each of the data points gets more compelling when it is looked at alongside each of these other reference points, because now all of a sudden there's this world of benchmarking, there's the ability to compare results, commercial rates to Medicare rates, looking at different types of hospitals nationally, looking at different hospitals within a state or a specific CBSA. So in addition to just that integration process, we are taking the data in the machine-readable files and parsing it essentially to remove a lot of the noise. If you've read anything about MRF data or spent any time learning about price transparency, you've probably seen some reports that there are duplicative rates, there's a lot of outliers, a lot of one-penny reporting, there are clinically implausible rates where it might report that someone like a psychiatrist is performing a double lung transplant.
Carol Skenes:
[24:32] Pretty sure that's likely not happening. So those sorts of rates which take away from the real, I would say, noteworthy rates that lead to that benchmarking comparison, we extract those. And then when others are using the data, they're able to get to the specific subset that is most meaningful to them.
Dr. Trevor Royce:
[24:50] You've aggregated these data, you've cleaned them up, now they're usable. And so what's the next step for people to use these?
Carol Skenes:
[24:56] Yeah, it's a great question. And it depends on who the stakeholder is, kind of how they're asking that question. So if you are a hospital or an insurance company, and let's say you have an annual negotiation coming up or, you know, every three years you're negotiating.
Carol Skenes:
[25:11] Your first question is, how do these rates compare in the market? So let's say you have a burn unit. How do these rates compare to other burn units nationwide? Or how do these rates compare to the hospital down the street, the hospital two hours away? They want to know these things because they're usually particular areas of shoppable services or areas where a hospital has invested a high amount of clinical expenses or research, areas where they are truly excellent in some of their service offerings. And they want to make sure, essentially, that those are the areas that they're focused most on in these negotiations. So it evens the playing field in terms of how providers and payers negotiate these in-network rates with each other because the rates are all now publicly available. And then from an employer perspective, you know, if you are self-funded or you are working with a broker to make sure your employees are, you know, going to what you want, right, is high quality care, not at low cost, right, but at a cost effective level. So you don't want them to have to go somewhere or they would have to get the same surgery twice, maybe because the quality wasn't as high. But if you're paying top dollar for something, you want to make sure that the quality is equally as impressive. And so they will use the data to say, OK, well, how do our rates compare based on these negotiated rates?
Carol Skenes:
[26:35] And what can we then marry the rate data with quality data to better understand that our employees are getting the best care in whatever geographic location they're located? And then last but not least, ultimately, a lot of this is for patients as consumers, right? To come full circle to your question about where is this going? I think that is the North Star is can we, as patients as consumers and as people who are scheduling care for our family members, can we know beforehand? A visit occurs, what our cost of care will be? Can we make decisions accordingly, price shop, or decide it's worth it to pay more because I trust this physician? And then after the service, can we have a high level of confidence that we're not going to get a second or third or fourth bill that's different from the amount that was quoted to us up front?
Dr. Trevor Royce:
[27:24] Amazing. I mean, what an amazing like catalyst you guys are playing to like make this whole conversation actually happen and drive prices in a like very rational way. I think that's just like very noble work what you guys are doing. Are we at the point yet where this is patient facing any of these data?
Carol Skenes:
[27:39] Yeah. So the No Surprises Act, which is one of the rules and laws that Turquoise really has built as foundational to the products that we're working on, has two different requirements. One for patients who are either going to be cash pay or they're uninsured, a good faith estimate. And then one for patients that have insurance called an advanced explanation of benefits. Both of those are required within the No Surprises Act. Neither of them have enforcement dates yet, but for technically savvy users who, you know, can look at just a very focused cut of these machine-readable files, if they understand their cost-sharing element, then it's a high barrier to entry, but that's exactly where we're getting. And so we're at this inflection point of, by nature, a machine-readable file is not a human-readable file. So it's on us and it's on the industry to take the information from these MRFs and translate it into say, OK, well, Tim needs a knee replacement. He's going to this hospital. He has this insurance. What does the in-network rate show in that machine-readable file? And what does that mean for Tim? Tim has a 10% coinsurance. He's going to pay X number of dollars. That's what that looks like, I would say, in a clean patient experience.
Dr. Timothy Showalter:
[28:55] That's really interesting. It seems like you guys, like, intersect with all the stakeholders. And I can see how you really do need an entity. And, like, frankly, it's, like, shocking that it, like, took this long to get a Turquoise Health that it's doing this but I'm curious like in the like on the business side how like what's the general like is there like subscription fees or like what's the general way that a company like Turquoise like makes makes money that's.
Carol Skenes:
[29:20] Right subscription fees in terms of the data is publicly available it is massive our co-founder Adam has written about the process we go through to parse a petabyte of data a month. So the sheer processing power and storage capacity needed for that, that is one element. But like we talked about earlier, one negotiated rate in a vacuum is not nearly as impactful as negotiated rates alongside other publicly available data sets or kind of general executive views when it comes to benchmarking, looking at things in an aggregate, being able to get the information that you need from the data without having to physically query the data yourself. That comes in the form of subscription to the data. And then we also have access to a product called Clear Contracts, where the actual documents where those in-network negotiated rates live, whether they're PDFs, CSVs, Excel files full of fee schedules, sometimes documents that are printed and handwritten, you know, with rates in the margins and scanned back into something like a SharePoint. We store all of that as well and can use AI to extract the relevant data.
Dr. Timothy Showalter:
[30:30] Okay. Yeah, I can imagine like you're saving these administrators a lot of time.
Carol Skenes:
[30:34] That's right. And if you have a large analytics team and you want query access to the data, that's available as well. It kind of depends on if you want that no-code experience of I have five minutes, tell me the facts. Or if I have two hours and I want to really dig into the queries and get down to the granular level.
Dr. Timothy Showalter:
[30:53] You know, you've got this long history within price transparency and made a lot of impact at Turquoise. Curiously, what are you most proud of that you guys have put together? What do you think is the most impact?
Carol Skenes:
[31:04] I think a couple of different things come to mind. The first of which is that we are hearing instances where a patient as a consumer is able to price shop or get a more favorable rate or in general just feel more educated on the questions to ask and the type of experiences they can have around scheduling their care. So that in particular, this is who we're doing it all for, right? These are the people who benefit. But I would also say from a legislative perspective, there is the hospital final rule, the transparency and coverage final rule, and the No Surprises Act that have all grown and matured over the last few years. And Turquoise has really become students to those rules and laws because they are, like I said, foundational to the work that we do. And because of that, we've done a lot of responding to requests for public comments and, you know, done a lot of writing about how the legislation can be improved. And a lot of that has culminated in getting footnotes in specific final rules. And then ultimately, our CEO, Chris Severn, was able to go to Washington and testify before Congress. So hearing the work pay off in terms of the people who are listening, who are foundational to moving this forward up in Washington is a proud moment for us.
Dr. Trevor Royce:
[32:17] That's amazing. I mean, I think it is so amazing that you guys can help push and support these legislation and like actually show the impact, like the direct impact of the patients for these types of legislations. I'm curious to hear you reflect a little bit in kind of a nonpartisan way, but just on the reality of sort of the supercharged environment in the U.S. On the political side and how a company like yours may be impacted by the winds of an administration. Because so much of this was enabled by this very forward-thinking transparency rules and regulations. I'm just kind of curious your reaction on that.
Carol Skenes:
[32:48] We are fortunate that price transparency has gone through now multiple administrations, Republican and Democrat, and the iterations have continued up through in February of this year, I believe February 25th, President Trump signed an executive order that was bolstering price transparency efforts. And so we do see this as a rare moment of where the previous President Biden also, there were updates to the hospital final rule during that administration. So we are seeing incremental progress from both parties. So we view it as our responsibility of making sure that, to exactly your point, what we are stating is what is best for the future of price transparency when it means getting real prices in front of patients. Then from that perspective, we're able to look at it not as a political hot topic, right? But as we can view what Turquoise is doing as a resource to empower some of these legislators to help both the stakeholders who are required to build these estimates and these machine-readable files be successful, but also help patients understand how they can get access to the information that they need.
Dr. Trevor Royce:
[34:00] Yeah, amazing. I mean, I think hopefully we can all agree, you know, within this call and And without that, price transparency, efficient marketplaces, lower prices, lower costs for patients is a bipartisan effort. So I hear you.
Dr. Timothy Showalter:
[34:12] Carol, we always try to like get a little bit of advice for listeners who may be earlier in their career who want to make an impact within, you know, an important issue like price transparency. And I'm just curious to get your thoughts on like, you know, going back to Georgia Tech student, Carol, or someone at a similar life stage. What advice would you have for somebody who wants to, you know, enter this space and make a real impact?
Carol Skenes:
[34:33] It really is the idea of being a student of the industry that you want to get into. There are a lot of very smart people who are solving very challenging problems, and it is helpful to kind of know the background of those. So a lot of these resources are publicly available. Read up on the things that interest you, ask questions, and I would say trust your instincts on areas where you think you might like to focus, but also strong convictions loosely held. You may learn some things in the process as to either why the current system is the way that it is or what efforts have been made to improve it previously. But if you view yourself as a student of the work you're doing, then I think it makes you a more successful, intellectually curious employee.
Dr. Timothy Showalter:
[35:19] Thank you so much. Thank you to Carol Skeen, Vice President of Product for Turquoise Health. It's been a pleasure having you in Health Tech Remedy.
Carol Skenes:
[35:26] Thanks for having me. I appreciate it. Good time.
Dr. Trevor Royce:
[35:28] Thanks, Carol.
