FAIR Health Board Access Interview with NancyMarie Bergman

As a breast cancer survivor, NancyMarie Bergman has experienced firsthand how healthcare cost transparency supports consumers when making critical healthcare decisions. Ms. Bergman served as a voice for healthcare consumers on the FAIR Health Board of Directors since FAIR Health’s inception in 2009 until her Board term concluded this month. In addition, Ms. Bergman is a small business owner: She and her husband, Drew, run Bells Nurses Registry and Employment Agency, Inc., which provides temporary medical staffing for hospitals in the New York metropolitan area. Four years ago, Ms. Bergman spoke with FAIR Health as part of the Board Access interview series about the opportunities and challenges faced by consumers navigating an ever-evolving healthcare environment. She spoke with FAIR Health last month in a follow-up conversation regarding the role of cost transparency in healthcare decision making and offered some parting thoughts regarding FAIR Health’s progress and future.

FAIR Health: FAIR Health recently re-launched its consumer website (fairhealthconsumer.org) with additional types of cost data that include de-identified, aggregated, in-network “allowed amounts” for medical services and cost bundles for 25 episodes of care (e.g., breast cancer treatment).

Having used FAIR Health’s cost information for your own healthcare decision making prior to the re-launch of the consumer website, how do you think the new cost data now being offered will bolster consumer healthcare planning?

NancyMarie Bergman: I am very excited about the new iteration of FAIR Health’s consumer website. It is a one-stop shop that enables consumers to make informed healthcare choices. Now, consumers across the country can access not only updated, accurate information about costs for health services but also background information about quality measures to help them choose a healthcare provider or service. The addition of in-network allowed amounts for medical services will go a long way in helping consumers manage their deductibles and minimize their out-of-pocket expenses. Another exciting new feature of the site is the cost bundles for 25 episodes of care; these are accompanied by corresponding explanatory educational content and videos. Moreover, consumers in New York State can now locate and choose from a list of healthcare providers with expertise in a specific medical procedure.

FH: Based on your experience advocating for yourself as a breast cancer patient, what is the most significant challenge to improving patient engagement in the healthcare sector? How can patient engagement be advanced?

NMB: First and foremost, patient engagement is a personal responsibility. When I was first diagnosed with breast cancer, I immersed myself in learning about every aspect of my medical condition. I did the research and spoke with my doctors to make the best decisions for my family and me. But, I had to visit multiple websites to access information about my medical condition and then had to make numerous calls to my health plan to figure out my allowable and out-of-pocket expenses.

Although more consumers have taken an active role in managing their health, they are still confused about their health benefits and the terms of their policies and are challenged by the inability to obtain the information necessary to have meaningful conversations with their physicians. Consumers need understandable information about their benefits and educational tools that help them comprehend their choices. They also need to be able to work with their doctors to become more actively involved in learning about their medical conditions and treatment plans. FAIR Health’s role will continue to be making consumers aware that they can obtain cost information about healthcare services and episodes of care so that they can compare the information before making potentially life-changing medical decisions.

FH: What role do you think healthcare consumers will come to play in the healthcare decision-making process over the next few years?

NMB: There used to be a popular ad campaign for a retailer whose slogan was, “An educated consumer is our best customer.” This statement has never been more relevant to healthcare decision making than now. The internet offers consumers immediate access to information about health services and their associated costs whenever they need or want it. Healthcare consumers can access their medical records through online patient portals and manage their out-of-pocket expenses through spending accounts in real time. Access to outcomes allows consumers to demand the best care from their healthcare providers—or they can choose to go elsewhere. The more information that consumers have about the cost and quality of care offered by their healthcare providers, the more satisfied they will be as patients. Armed with cost information, consumers can now negotiate costs with their physicians, which may ultimately reduce their healthcare expenditures.

FH: The national healthcare debate has largely focused on controlling costs and increasing coverage. What other issues should be given greater attention in the public forum?

NMB: The focus on cost and coverage should be balanced with a focus on the quality of care and the outcomes derived from that care. Additionally, we need to focus more on how we should allocate the costs we are trying to control, by asking questions such as: What is the right allocation of costs among preventive, alternative and episodic medical costs? One other issue that is worth additional debate is whether we should consider the move to a single-payor system.

FH: How has the role of cost transparency in the marketplace evolved over the past few years?

NMB: FAIR Health’s mission always has revolved around transparency and access to data. FAIR Health has continued to push the envelope so that all stakeholders in the healthcare ecosystem—including payors, providers and consumers—have access to objective and accurate data.

Speaking as a consumer, I recall that it wasn’t that long ago that medical/dental expenses, patient responsibility and covered procedures were unknown or unclear until an invoice or an explanation of benefits showed up in the mail, sometimes weeks after a healthcare visit. Today, thanks to innovation and the success of FAIR Health, consumers can access information about reimbursement, out-of-pocket costs and educational tools all on one website, in addition to accessing the information through a mobile app. With these data readily available, we now can better advocate for ourselves and make the best-informed decisions for ourselves and our loved ones. Cost transparency ends the confusion of surprise bills and allows consumers to budget for out-of-pocket expenses and prepare emotionally for what lies ahead.

FH: You joined the FAIR Health Board of Directors eight years ago after receiving an unexpected bill for breast cancer treatment. Reflecting on FAIR Health’s growth as an independent source of objective healthcare price and utilization information, are you surprised about FAIR Health’s progress and the role that it has come to play in the healthcare sector? Looking to the future, what do you think the next few years hold for FAIR Health?

NMB: To answer your first question: In a word, no—I am not surprised about FAIR Health’s accomplishments. In 2008 when I was dealing with questions about my diagnosis and prognosis, just thinking about my in- and out-of-network reimbursement and costs was overwhelming. There was no place for me to turn to access transparent information that would help me make my life-changing decision. From its inception in 2009, FAIR Health has made it its mission to lead as a source of unbiased, independent cost information for all healthcare stakeholders. Today, it offers an expanded set of information for consumers: educational tutorials that help to explain its data in simple, consumer-friendly language in English and Spanish; negotiated in-network “allowed” amounts; and cost bundles for 25 episodes of care. The updated consumer website, fairhealthconsumer.org, and its New York version, YouCanPlanForThis.org—with its corresponding campaign—have certainly raised the bar in providing consumers with cost data and with information about healthcare providers. The key is to continue informing consumers, bringing them educational and informative materials and attracting visibility to the website.

FAIR Health’s Board of Directors, which comprises current and former CEOs of prominent insurers and medical facilities, attorneys, academics and healthcare policy makers, together with its outstanding management team, will continue the important task of challenging the status quo and securing FAIR Health as the preeminent source of independent and objective price and utilization information.