Reflections from a Day of testifying on The Hill

After spending several hours on Wednesday testifying before the House Energy and Commerce Subcommittee on Health, I’m left with a renewed sense of momentum and optimism for eliminating the financial complexity of healthcare. It’s an exciting time to be challenging the opaque, burdensome healthcare transaction that exists today and building a framework for the future, all while not needing to wear a business suit every day. The little things!  Here's a few takeaways I had from the hearing.

Thankfully, the staying power of price transparency data is no longer up for debate

Back in 2023, Turquoise CEO and co-founder Chris Severn had the opportunity to be a witness at a hearing on price transparency. The questions and landscape back then were noticeably different. In many ways, the themes of that day questioned if there was any actual utility in price transparency data. The chief concerns focused on the quality, comprehensiveness, and accuracy of the data hospitals and payers were posting.

Today, price transparency has solidified its standing as a durable, bipartisan policy priority. That clear signal came from both Republicans and Democrats on the subcommittee, as well as the other four expert witnesses on the panel, and affirmed the value of what the hospital final rules and Transparency in Coverage (TiC) have built. There was no serious debate about whether this data should continue to exist, and instead we were able to focus on how to take the next meaningful steps toward understanding the cost of care. After years of data-focused discourse, we celebrate that hard-won consensus. It’s also right in line with how we’re looking ahead at Turquoise.

We need better consumer products to simplify that data

Members on both sides of the aisle acknowledged something Turquoise, alongside others in the industry, has been saying for years: standalone MRFs are not a consumer product. MRF data is most certainly producing measurable market effects among providers, payers, employers, and life sciences organizations as prices converge, rates become more competitive, and employers gain access to data they didn't have before. But a raw MRF file can’t help a patient with a ChatGPT account asking what that CT Scan on the calendar for next Thursday afternoon will cost on their Aetna PPO insurance. Getting to that cost requires bundling codes into complete procedure packages, integrating real-time benefits, and delivering a plain-language estimate. Those requirements translate into the very things federal legislation needs to incentivize and enable at scale. The committee's interest in thoughtfully designed AI-enabled products, open license service bundle standards, and consumer-friendly packaging was encouraging. It’s the right next conversation.

Payers were largely absent from the accountability discussion

The hearing covered hospital transparency enforcement thoroughly, but payer enforcement was conspicuously absent. Payers have been required to post TiC files since July 2022, and to date, meaningful enforcement of those requirements has not occurred. A comprehensive transparency enforcement framework must hold both payers and hospitals accountable for MRF accuracy and completeness. Several of the bills drafts included in the hearing contained language around payer enforcement, so we’ll keep an eye out on any future discussions that focus on TiC data quality.

Prior authorization is a process transparency problem. Turquoise believes there's a framework solution

The hearing also surfaced frustration with prior authorization delays and denials. The administrative burden impacts providers and patients alike, and several Congressmen and women hit on the root cause of the issue: there is no shared, standardized, computable understanding of what requires authorization, how to request it, or how coverage decisions get made. Every payer has different authorization rules, formats, and processes. The result is hundreds of hours of clinical and administrative staff time wasted navigating an ever-changing, moving target of a system.

At Turquoise, we see a clear path toward resolution through a Universal Clinical Coverage library. We envision a shared, open license set of coverage rules that give providers, payers, and patients a computable understanding of what is covered prior to scheduling. When both sides of a transaction operate from the same coverage logic, we are significantly closer to real-time, pre-appointment authorization that occurs as a patient is scheduling care and determining cost. That's the process transparency vision embedded in the PATIENTS Framework, and Wednesday's conversation about authorization burdens made clear that Congress is ready for that conversation too.

All in all, everyone agrees there’s more good work to be done

We’re in a motivating new era of lawmaking that is allowing Turquoise to ask how far we can get with upfront guaranteed cost of care and how fast we can get there at scale. We’ll be closely following along to see which of the bills discussed on Wednesday come up for a vote, if any of the language in the bills changes, and how we can continue to be a voice supporting a transparent and simplified future state.

I’m grateful to the Subcommittee for the opportunity to testify, and now it’s time to get back to building!