For episode six of season two, we were joined by AnnMargaret McCraw, CEO at Midlands Orthopaedics & Neurosurgery, P.A..

Prior to becoming CEO, she spent 17 years working in human resources and practice management at Midlands. They have become a leader in price transparency for private groups, posting bundled pricing online for their patients to easily access. She is particularly motivated to pursue meaningful healthcare reform that promotes both cost containment and quality in the context of private physician practice and broader use of ambulatory surgery centers. 

Our hosts for this episode, Steven Cutbirth and Patrick Gaul, discuss several topics with AnnMargaret, including price transparency, how surgery bundles work for patients, TPAs, and health plans, and how the U.S. got to where it is with high healthcare costs.

You can listen to the whole episode here or on Spotify, Apple Podcasts, or wherever else you listen to podcasts. If you’re short on time, we’ve included a few highlights from our conversation below:‍

Patrick: “You seem to have a deep caring and understanding for patients, recognizing them as individuals and consumers. What led you to become a proponent of price transparency and being willing to take on the brunt of work required to make it simple for patients to understand the price at your facility?”‍

AnnMargaret: “I am a teacher-learner at my core. And that's relevant to this because it's why I am passionate about some things that maybe if I had a business degree, I might not be as passionate about. I come from a teacher-learner place and that's the lens through which I view the world. And that's different than your traditional business background. So I care deeply about enabling and equipping other people in whatever they're doing, whatever people they are. If I just meet them in the community or they work with me. So in this case, staff, providers, patients, all of those folks, I want them to be successful and I want to figure out how to enable them and equip them, and make the processes around what everyone's doing easier and more efficient.

My specific sphere of influence over the past almost 20 years at this point has been in healthcare. So it is admittedly very complex, and insurance makes it all the more complex. And so I quickly realized when I got here, you know, as a patient when you get an EOB, how do you interpret that? It has five columns on the EOB, what does that even mean? And then before you even have the service how do you know what your benefits are? So we spent a lot of time in this practice prior to the price transparency ideas of just trying to help people understand what their benefit plan says, how in the world do you anticipate what your out-of-pocket costs might be beyond your copay? So we were trying to navigate those waters with patients and just make the patient experience better far before we really thought about the transparency piece of it. But it's the natural progression. Leading from just trying to make the patient experience better for patients on the financial side, you have the clinical side of it and what they're actually here for, but a whole other aspect of our business is trying to smooth that experience out for them so they're not in the stress that comes with a financial component of healthcare that just makes everything else more difficult. So if we can try to smooth that out for them, then hopefully why they actually came to get their knee replaced or their Achilles repaired doesn't have to be even more stressful because they're worried about the financial component.”‍

Steven: “Since the United States is a consumer obsessed market, how do you think healthcare pricing became so complicated to begin with and will we ever be able to simplify it?”‍

AnnMargaret: “So I think that the complexity began at the point that insurance became integrated with healthcare. And when did that happen? I actually had to do a little research myself to figure that out. So the first hospital insurance program that I could find in my little bit of research appeared around 1929 at Baylor University System. And then it evolves around World War II, which was the first time employer-sponsored healthcare came to play into play. And then that becomes a normal thing. And then you jumped to 1965, where the government gets involved with Medicare and Medicaid. And from there, we've had this whole progression in managed care and increasing complexity. So when we think about the free market and the consumer-driven land that we truly are, those principles really only impact people when they are paying the bill. Early on, insurance did pay most of it. So it's really only been in the past maybe decade where the prices are soaring and they're being shifted back to the consumer. So I would say that for decades, we just got complacent as healthcare consumers because we really weren't consumers. We were consuming it but we weren't paying for it. And when you're not paying for it, you get a little lazy about that. You don't care. And then I think that analogy with the frog and the boiling pot, we feel like it's all of a sudden the prices have gotten out of control, but that's not really true. They were gradually changing. Planned designs were changing. Gradually cost is being shifted. But now we're at a point where so much of the cost is being borne, even if you are insured with high deductibles by the purchaser, the consumer then very suddenly feels like, ‘I can’t afford this.’ And then obviously employers that are still sponsoring plans are bearing the brunt of increased costs as well.”

To hear the whole conversation, click here for the full podcast episode. You can also hear more from AnnMargaret by visiting midorthoneuro.com to read her educational content on a wide variety of topics. You can also contact AnnMargaret by emailing her at annm@midorthoneuro.com.