The Missing Narrative on Making Healthcare Affordable

By Neel Shah, MD, MPP and Jordan Harmon, MHA

We founded Costs of Care in May of 2009 with (we admit it) a highly literal, and seemingly uncreative name.

As it turned out, our name, buoyed by exceptional timing, may be responsible for catapulting Costs of Care onto the national scene. In May 2009, healthcare reform was at the top of the new President’s agenda and the phrase “costs of care” was being searched on the Internet thousands of times per day. Before long, our registered domain name——floated to the top of the Google search rankings. Within months, our fledgling website was brimming over with visitors who were trying to understand why healthcare costs in the United States are so irrational and opaque. We also started to hear from patients, nurses, physicians, and other health professionals who were seeing the consequences of this opacity everyday on the frontlines of clinical care.

These collective voices generated Costs of Care’s first national project. We all know healthcare costs are too high and that to make care more affordable we need policymakers to flex large muscles—payment reform and tort reform will be enacted in halls of Congress. But a parallel story was also emerging in the halls of hospitals, and the examination rooms of community practices. We realized that patients and clinicians were also seeing routine opportunities at the ground level to make decisions differently: decisions that could lead to better care at lower cost. Does every patient that arrives to the emergency room with chest pain really need the exact same tests? Shouldn’t we be able to give patients an estimate of their treatment costs, for services that are completely routine?

We decided that there are many capable organizations suggesting good policy, and occasionally we are one of them. But someone also needed to shine a light on this other narrative, the day-to-day opportunities that those on the frontlines of healthcare delivery are seeing in every healthcare facility in every corner of the country. So we made a deal. If you send us your story about how knowledge of healthcare costs at the point of care can help us make better decisions, we will commit to publishing it. The most compelling stories will get a $1000 cash prize. It has to be a real story and you have to be willing to put your name on it. That’s it.

Over the years we have now collected hundreds of stories and helped develop a critical dialogue about the role of caregivers in healthcare spending. These stories have also helped drive solutions for making costs more rational and more transparent from the ground up. This Spring, we’re looking to you again to elevate the conversation to it’s next phase. In 2015, payment reform has become a reality. It’s time for us to better define what actual healthcare delivery should and should not look like—we want to hear from patients, nurses, physicians, students, and anyone else who has seen unaffordable care take place and thinks the care could have been delivered differently. We also want to hear from any of you who have seen care being delivered right—clinicians and patients going out of their way to solve the cost conundrum. In partnership with the Association of American Medical Colleges, we’ve enlisted some healthcare heavyweights to help us choose the very best stories and make sure these stories are prominently featured. We believe that re-injecting the missing narrative into the public discourse may provide inspiration for the hard, wide-scale efforts needed to change our routines and delivery of care.


Neel Shah, MD, MPP is the Founder of Costs of Care and co-author of a new book for healthcare leaders: Understanding Value-Based Care. Jordan Harmon, MHA is Director of Advocacy Initiatives at Costs of Care.

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