Episode 457

EP457: It's a Big Thing: Medical Spread Pricing. So, Let's Talk About Contract Transparency, With Cynthia Fisher

Dec 5, 2024

34:15

Episode Description

In this episode, host Stacey Richter talks with healthcare entrepreneur Cynthia Fisher about medical spread pricing and the case for contract transparency. Fisher explains how hidden fees and spread pricing by middlemen lead to substantial overcharges for employers and patients in the U.S. healthcare system — and lays out real numbers to prove it. In one example she cites, a self-insured employer paid $4 million for a claim; the provider was paid $876,000. The conversation covers recent lawsuits (including the one against Cigna) that expose these practices, the legislative progress being made on price transparency, and how transparency can ultimately transform the industry. Insights are also shared from industry experts who have been previous guests, including Chris Deacon, Justin Leader, and Andreas Mang.

WHAT YOU'LL LEARN

✅ What medical spread pricing actually is, and why it isn't "change in the couch cushions" the way PBM spread pricing adds up to billions of dollars

✅ The real numbers behind one claim: an employer paid $4 million, and only $876,000 of that made it to the provider

✅ What the lawsuit against Cigna reveals about how carriers are learning to replicate PBM-style spread pricing tactics

✅ Why American competitiveness is affected by how much employers spend on healthcare, and why transparency addresses the root cause rather than a symptom

✅ What's happening across the country to empower price transparency in healthcare, and how employers can use existing laws to demand accountability

WHY THIS MATTERS

"This is a thing now, medical spread." Just as PBM spread pricing quietly added up to billions of dollars, medical spread pricing is doing the same thing on the medical claims side — hiding in plain sight inside contracts that employers signed without full visibility into the numbers. Contract transparency isn't a nice-to-have; it's the mechanism by which employers and unions can hold carriers and providers accountable for what they're actually being charged.

MENTIONED IN THIS EPISODE

EP419 with Andreas Mang: Apple Podcasts | Spotify | Other Apps

EP452 with Cora Opsahl: Apple Podcasts | Spotify | Other Apps

EP453 with Claire Brockbank: Apple Podcasts | Spotify | Other Apps

EP433 with Justin Leader: Apple Podcasts | Spotify | Other Apps

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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00:00 Introduction.