The Upfront Pricing Phenomenon | Out-Of-Pocket

As more data from EMRs + claims becomes available and machine learning becomes better, payers and third-party administrators are getting increasingly better at guessing how much your care journey is going to cost them.

If you believe that healthcare will eventually be more consumer oriented, providing upfront costs and predictability will be a key component to that going forward.

Deductibles are weird

I distinctly remember someone once telling me that they hadn’t gone to a primary care physician in years because they didn’t know how much it was going to cost.

This is bad for everyone: avoiding care means hospitals don’t get paid, patients are potentially getting sicker, and insurers will end up paying for more serious diseases that weren’t caught earlier.

As this segment increases, more viable business models NATIVE to the cash pay population can be built.

There’s a wave of products that have figured out what bundle of preventive/recurring care they can sell for a monthly price that people will pay for just for simplicity and peace of mind.

Deductibles have become confusing for most people - studies show most people don’t even understand what actually counts towards their deductible or what’s covered for free. Plus, deductibles are now so high that they effectively only act as insurance against catastrophes.

Interestingly, there seems to be a wave happening where companies are focusing specifically on making prices fixed and transparent for a very specific episode of care.