Transparency Tool Seeks End to ‘Secret Pricing’

Noting that as much as $3.2 trillion a year in medical care is “secretly priced,” an entrepreneurial physician named Bill Hennessey is on a mission to unmask those costs for self-insured employers with the help of brokers and advisers. The secret weapon: an ability to identify by ZIP code known charges and claim allowables before services are actually rendered. The proprietary platform, Pratter, instantly identifies, itemizes and targets a host of outpatient procedures, seeks to break the confounding cycle of contractual arrangements with TPAs or insurance carriers that prevent employers from auditing their own claims.

Bill Hennessey, MDOne adviser working with Pratter is Steve Dalaba, co-founder and managing partner of WBS Benefit Advisors. He was surprised by the eye-popping variation of a simple lipid panel test in Pittsburgh, which a live demo of Hennessey’s transparent pricing tool pegged at anywhere from $25 to $1,900. “We fully believe that knowledge is power,” he says, noting how more careful shopping by employees will save their employer money as well.

Hennessey’s Pratter startup recently was named by EBA to a list of 21 innovators who are transforming benefits technology. He says employers not only have a right to know, but not knowing this information violates their fiduciary responsibility under ERISA to manage all benefits. Employers in this situation obviously can’t manage what they can’t measure, he adds... He knows of one company that spent $60 million on healthcare last year, half of which was revenue instead of CPT coded. With no way to itemize those costs, which are often hidden by nondisclosure agreements, it was a case of the tail wagging the dog...