When the pandemic hit, we leaned heavily into our response to COVID-19. One of the many things we did was create a free map of sites around the U.S. that did COVID-19 testing. Nothing special here — lots of these popped up and helped people around the country get access to testing.
The first version was literally the result of a small team at Carbon Health calling thousands of hospitals and health centers around the country and some scraping. As time has gone by, we’ve built some automated processes. Nowadays, there are lots of ways to access testing, and access to testing is pretty widely available. But tons of people used our test finder, and friends who knew I worked at Carbon Health would occasionally reach out if they needed a test (for example, if they were about to travel or had been recently exposed), and I’d just point them to it.
The response to these tools and the rapid onset of the pandemic revealed something about healthcare in the U.S. that it might otherwise have taken us a while to learn (healthcare veterans would know this, but I was a noob): for patients, finding exactly what you need in healthcare is hard.
There are a few reasons for this, some of which were specific to the pandemic, but most are general.
• COVID-19 testing was a new service and was rolled out quickly but unevenly around the U.S. (specific to the pandemic)
• Most healthcare isn’t paid for by consumers, so health information is controlled by those who pay (insurers)
• Most health resources (like insurance portals) are built for insured consumers by insurers.
All this means that if you’re uninsured, the quality of information available to you is literally worse than the quality of information available to an insured patient. For example, an Aetna user can go to the Aetna portal to find in-network providers. But if you’re one of 30 million uninsured Americans and you need a mammogram, you can’t find the cheapest one near you. So we’re building a way to do that.
All our prices are already online. We want everyone else’s prices to be online as well.
Our hypothesis is simple:
1. Make it easy to find the lowest-cost services near you (like the cheapest nearby X-ray)
2. Train patients to expect to know how much services will cost before they pay for them
3. Low-cost providers will publish their prices and get more patients
4. Other providers will have to lower their costs and publish their prices
There’s no uniform database of self-pay prices for healthcare services for all providers in the U.S. As we started this initiative, we found a few organizations that had assembled massive databases of healthcare pricing from a combination of providers and insurers. In every case, they stopped talking to us once they realized our goals. Even those organizations have only partial data, which is assembled on behalf of insurers, so the data they do have contains significant distortions, as providers inflate their listed self-pay prices to create negotiating leverage with insurers. A real patient would pay a significantly discounted price, and those discounts aren’t captured anywhere.
To solve this, we’re doing things that don’t scale — where prices are listed, we’re scraping them. Where they’re not, we’re calling facilities to ask for their prices. Even in the cases where we called the facilities, the person answering the phone often did not know and couldn’t find the self-pay price for their practice.
To date, we’ve shipped three maps for diagnostic services: COVID-19 testing, flu shots, and mammograms. We’re experimenting with COVID vaccines (to support the pandemic) and endocrinologists.
Over the long term, we want to make all pricing for all standardized services (diagnostic and otherwise) transparent, so patients can know what they’ll pay before the visit. We’ll eventually build easy ways to search for specialist providers, but for that, price is the wrong selection criterion, so we have to give it more thought. More to come.
As always, please let us know here if you have questions or feedback.
