Could the same e-commerce trends that disrupted the travel industry help reduce skyrocketing healthcare costs? Why a new approach could save patients and payors billions of dollars.
It's no secret that U.S. healthcare costs have climbed sharply over the past several decades, particularly for elderly and poor people. What may be more shocking, however, is the hidden amount of waste in these costs due to overtreatment, pricing failures, fraud and other factors.
Online tools that improve price and quality transparency could turn the healthcare delivery model on its head.
Turns out, e-commerce may be the cure. A new Morgan Stanley Research BluePaper finds that arming healthcare consumers with the same tools that revolutionized how they shop for travel or select restaurants could help bring costs and waste under control.
“Our research suggests that online shopping tools would be the most comprehensive and practical solution to better managing costs," says Ricky Goldwasser, head of research for Healthcare Services and Technology. “As we've seen in other industries, the use of reviews and price transparency could bring significant savings."
In the report, Goldwasser and her colleagues examine why putting better data in the hands of consumers and payors could go a long way toward curbing needless spending. With the online-travel-agency industry as a model, the analysts dubbed the hypothetical tool "HCX."
The upshot: Reducing spending waste could cut up to $800 billion in yearly U.S. healthcare spending costs, with $260 billion of that coming from Medicare alone.
Heathcare as a Percentage of GDP
For many Americans, healthcare is a major household expense. According to a Kaiser Family Foundation study, U.S. healthcare spending rose to 18% of GDP in 2017 from 6% in 1970, far outpacing the comparable country average, which increased to 11% from 5%.
Morgan Stanley estimates that fewer than half of patients know the cost of service prior to a procedure; even fewer know their out-of-pocket costs. However, many would be shocked to find out that prices for the same procedure, in the same market, can vastly differ from one provider or facility to the next.
In a 2015 study from Blue Cross Blue Shield, the cost of a hip replacement in Boston varied by 313% between the lowest- and highest-cost providers. The price for cholesterol-screening swung 1,275%. While not every medical procedure could be price-compared online, an estimated 30% to 40% of all medical procedures are “shoppable.”
The big issue here, of course, is price transparency. Even when providers are upfront about costs—and a new rule requires that hospitals post their prices online—it's difficult for consumers to get an accurate estimate. No uniform standards exist for how procedures and prices are described, and insurance coverage further muddies the waters.
“The healthcare sector is built on intertwining relationships between providers, manufacturers, payors and patients," says Zack Sopcak, equity analyst covering Healthcare Facilities and Managed Care. “But the combination of healthcare costs increasingly shifting to the patient, accessibility of information, and technology is empowering individuals to approach healthcare as consumers rather than as just patients."
Estimates of U.S. Healthcare Waste in 2011
|$ in Billions|
|Annual Cost of Medicare and Medicaid in 2011a||Annual Cost of U.S. Healthcare System in 2011|
|Failures of care delivery||26||36||45||102||128||154|
|Failures of care coordination||21||30||39||25||35||45|
|Fraud and abuse||30||64||98||82||177||272|
|% of Total Spending||21%||34%||47%|
b Totals may not match the sum of components due to rounding
Source: JAMA, Morgan Stanley Research
To be sure, just as digitization has dramatically changed media, retail and communication, online tools that improve price and quality transparency could turn the healthcare delivery model on its head.
“We envision a site along the lines of online travel entities, with physicians, facilities and procedures searchable by reviews and costs,” says Brian Nowak, who covers the U.S. Internet industry. “As costs increasingly shift to the patient, individuals will approach healthcare as consumers, empowered by technology and the accessibility of information, particularly boomers who tend to be savvier at online price-comparison than they often portrayed.”
It's too soon to say which entities could take the lead, but an early 2018 announcement of a joint venture between the world's leading e-commerce company and two major financial services firms fired a warning shot across the bows of the industry.
The joint venture may develop the firepower to crack open healthcare spending, but innovation could come from other sources. Consumer-centric tech companies with high brand recognition and the ability to create user-friendly experiences could join the fray. Insurers could also use their incumbent status to enter the field, but first they will need to navigate regulatory complexities, contractual relationships and the fragmented nature of the healthcare system.
Whatever its form, HCX represents a $240 billion revenue opportunity for entities that create the tools, with $70 billion in revenue for Medicare alone. Managed-care companies may ultimately benefit from any efforts to empower patients, but high-priced facilities and providers could feel more than a pinch.
The solution for plugging healthcare spending leaks will likely come from the private sector. Even so, the U.S. government could be an ideal administrator of a ready-made tool focused on Medicare, which accounts for 15% of the federal budget.
“Medicare has the most concentrated pool of money and is the least complex to navigate," says Leigh Pressman, equity analyst on the Healthcare Facilities and Managed Care team, who notes that the program has taken a significant step toward a managed-care approach with Medicare Advantage.
Meanwhile, Baby Boomers are becoming the largest cohort of Medicare users. Many in this group are comfortable with technology and accustomed to shopping online for other services.
10% of Medicare Beneficiares Spent 59% of Their
Total Income on Healthcare Costs in 2013
“For the Medicare population, saving money on out-of-pocket costs would be incentive enough," says Sopcak, who notes that, by 2029, all boomers will have aged into Medicare. “Although HCX is geared for the patients' use, we expect that a more engaged patient would alleviate the burden on the system."
Morgan Stanley estimates that even relatively modest cost reductions could add up to $52 billion in savings for Medicare. Once HCX is proven within Medicare, it would likely be widely adopted by the employer market, the largest cohort in the U.S. All told, more efficiencies in pricing could save $157 billion in unnecessary expenditures at the midpoint of estimates—and more than $800 billion at the high end.