By Whitney Downard
Indiana Capital Chronicle
INDIANA — U.S. Sen. Mike Braun — the Republican nominee for Indiana governor — made a surprise appearance at the National Healthcare Price Transparency Conference Monday, earning recognition for his work on health care price transparency on the federal level.
Conference emcee Gloria Sachdev, the president and CEO of Employers’ Forum of Indiana, presented both Braun and fellow U.S. Sen. Bernie Sanders of Vermont with an award recognizing them as “Champions of Healthcare Price Transparency.” The two, at opposite ends of the political spectrum, worked together on a measure to tackle transparency for hospital and insurer pricing.
Braun’s appearance coincided with the release of the latest hospital prices study by the RAND Corp., a think tank, which found Indiana’s hospital prices were 8th-highest in the nation. Also on Monday, the Employers’ Forum of Indiana launched Sage Transparency 2.0, a dashboard providing cost breakdowns and revenue information for hospitals.
The Indianapolis conference drew nearly 200 in-person attendees and dozens more online, with speakers like entrepreneur and venture capitalist Mark Cuban, national accountant experts, state legislators and patient advocates. The forum, which hosts the conference, seeks to improve health care transparency, prices and quality with an emphasis on the value for employers.
Indiana’s hospital lobbying organization continued to push back against the RAND analysis, pointing to its own data on thin — or even negative — hospital margins and saying the study’s data provided a “distorted” view of prices in Indiana.
Brian Tabor, Indiana Hospital Association president, said the study didn’t include the entirety of spending on hospital and health system services, which would actually put Indiana in the middle of states in terms of costs nationwide.
He also said Monday’s presentations “(beat) up on hospitals, particularly health systems,” without providing solutions or acknowledging the full context of Indiana’s low Medicaid reimbursement rates.
Price Data And Information
The biggest takeaway from the RAND study was that employers paid, on average, two-and-a-half times more than Medicare prices — a federally set number that is supposed to be close to a “breakeven” number for providers giving care.
But Chris Whaley, one of the RAND researchers and a professor at Brown University, noted that there is a lot of variation between states and within states but Indiana’s prices still ranked high even when compared with its neighbors. For example, Michigan’s prices compared to Medicare hovered below 200% while Indiana was closer to 300%, on average.
Whaley said the purpose of the study was to give employers information on prices negotiated on their behalf. The analysis then compares prices at more than 4,000 hospitals and 4,000 ambulatory surgical centers with Medicare.
The key driver to prices appeared to be the percentage of market share a hospital system had in its area, not its quality or payer mix. That means hospitals with high low-income populations on government insurance programs fared no better or worse than their counterparts.
The lack of market competition is a problem in nearly every corner of the country, according to Whaley’s analysis, and state legislators have been interested in exploring the impacts of monopolies on Indiana’s markets.
Braun said that “sooner or later the (Federal Trade Commission) will get involved” when it comes to monopolies, stressing that he “(doesn’t) want the government meddling in anything other than keeping the markets competitive and fair.”
Hospitals, however, say they’re struggling.
A recent analysis from Kaufman Hall promoted by the hospital association found that Indiana’s hospitals had just a 1% operating margin in 2023, compared to national margins of 2.3%. Indiana hospital profits grew more sluggishly than their peers while expenses grew faster.
That directly contradicts what another Monday presentation from the National Academy for State Health Policy found. Its presentation, with a focus on its Hospital Cost Tool, found that Indiana’s hospitals had higher median net profits than the national average.
Tabor said that presentation relied on information from Medicare cost reports, rather than audited financial data. But presenter Marilyn Bartlett with NASHP said the audited financial statements don’t provide the same breakdown for each hospital like Medicare cost reports do.
Kaufman’s analysis, on the other hand, uses audited financial data for the entire health care entity but not its investments — the same information bond markets use — according to Tabor.
The Importance Of Transparency
Price transparency directly benefits patients and — by extension — employers, said Cynthia Fisher, who founded patientsrightsadvocate.org. Fisher detailed individual experiences of people trying to navigate the complexities of medical billing and ways her organization tried to support patients and intervene on their behalf.
One woman received a quote for a hysterectomy at $5,000, only to see a $74,000 bill that her insurance denied to pay, Fisher said. The hospital eventually placed a lien on her house during payment negotiations.
Her organization’s intervention and review of the hospital’s pricing file found that the bill should have been closer to $8,000, but the process took more than four months.
While there has been national momentum to provide price transparency, Fisher said such standards are unevenly applied across the country. In states like Indiana, just over half of hospitals conform to such requirements compared to the one-third of hospitals nationwide posting prices publicly.
Tabor pushed back on this assessment, saying that the methodology was “subjective” and others had found nationwide compliance to be much higher — closer to 80%.
Price transparency efforts have spanned across three presidential administrations, most recently with President Joe Biden increasing fines to $2 million. Fisher said just two hospitals have been hit with those fines.
The lack of transparency has likewise influenced prices in drug markets, said Cuban, who co-founded Cost Plus Drug Company. The firm directly sells generic medications to consumers and has roughly 2,500 ones listed. It recently expanded to manufacture its own generic drugs.
Cuban compared his site, which shows a company markup of 15% alongside a $3 pharmacy handling fee and $5 shipping fee, with traditional pharmacy systems that often must negotiate prices with Pharmacy Benefit Managers or Third Party Administrators.
He pushed the employers present to be proactive in accessing their claims data held by insurers or other contracting parties, something Indiana recently formalized in a 2024 law that requires such partners to allow access and regular audits.
