Joe Wisniewski, AVP of Channel Sales at Turquoise Health, on the VatorNews podcast

Turquoise Health is a healthcare pricing platform that has raised over $55 million

In 2025, we may see radical top-down changes to our healthcare system as new heads of the NIH - National Institutes of Health, HHS - Health and Human Services; the CDC - Center for Disease Control and Prevention. And the FDA - Food and Drug Administration as well as CMS - Center for Medicare and Medicaid services.

How will the heads of these government agencies ignite tech innovation in the healthcare industry?

We’re speaking to many healthcare tech CEOs and executives to see what they think. 

One executive - Joe Wisniewski, AVP of Channel Sales at Turquoise Health - believes price transparency will be a continued priority for the incoming administration. 

Turquoise is a healthcare pricing platform that uses data from hospital and payer machine-readable files to eliminate the financial complexity of healthcare. It raised $55.3 million from august VCs such as Andreessen Horowitz and Bessemer Venture Partners.

Highlights from the conversation:

• 1:35 - Joe's career trajectory, getting involved in zoning, and how that relates to healthcare: “It sounds unrelated to healthcare, but this really helped prep me for the acronym soup that is healthcare, of all the different things you get exposed to, and when I went to my school, American University, the first thing I noticed freshman year, the reason why I started thinking about zoning law freshman year, was because I was crammed in a dorm with three people, instead of two. We were running out of space on campus and there was this big back and forth about developing one of our parking lots into additional dormitories and the problem with a lot of policy issues is that it's always long term gains for short term sacrifice. Somebody needed to get involved to develop this parking lot, knowing they weren't actually going to see it; by the time those new dorms came in I was long gone, but somebody had to start the clock and the university was starting to push it, and there was this big initiative to get students to run for local office and get engaged. And, traditionally, there was one student who represented the campus. It was gerrymandered into one district, and I decided to run for an off campus seat on this local advisory neighborhood commission seat. Think of DC politics, that's like our version of a little mini city council, and the city council's like the state legislature.”
• 8:21 - Joe got involved in healthcare and Turquoise at the start of COVID when his mother was going through cancer treatment: “[I was] just going through that stressful situation, of getting a boatload of these bills that look really scary, and then realizing that, hey, there's really complicated math behind each one of these invoices, and no one's sitting there laughing maniacally saying, ‘Great, let me send these bills and ruin somebody's life.’ No one's doing that in this system. But because the billing is so complicated, the end result can be someone feeling like that's what's happening. Whenever I share this story with folks, it's always eye opening, because usually they're like, ‘oh, I have a story just like that with themselves, a friend, a family member, whatever it is. And the scope and scale of what we were trying to do at Turquoise really attracted me to the role.”
• 14:10 - How Turquoise makes healthcare costs transparent: “You've got the really easy to shop for services; think blood tests, MRIs, they tend to be preventative, colonoscopies, things like that. Those are things that, right now, people can shop for, and you don't need a medical degree, you don't need to be an MD, you don't need to really know that much to say, ‘great, my blood test costs $200 here with my deductible, or it's going to cost $100 here. I should go and save $100 and go to that lab instead of the hospital.” Whatever it is. So, that's one bucket, and then the other bucket are the non-shoppable ones, the heart attacks, the major surgeries, these really complicated, what we call ‘episodes of care.’ You don't necessarily get in the ambulance when you're having a heart attack and say, ‘Oh, wait, wait, wait, what's the price before you take me to this?’ No, you need to go and then we can figure it out. So, that separation is critical, because pricing transparency can help out the shoppable services side right now, and there is a future where it actually still can help in the long term for those larger ones.”
• 22:17 - Privacy and confidentiality around healthcare pricing: “If I'm the insurance company or the payer, and I'm negotiating a rate with you, and you're a local hospital, I might tell you, ‘Look, I'm going to give you the best deal in town. I'm going to pay you $1,000 for every MRI that you do.’ Before, you had no way of knowing if I'm actually telling you the truth. Are you getting the best rate? It was really difficult for you to do. After the hospital price transparency rule that CMS pushed through in January 1st of 2021, effectively what CMS said was, ‘you have to post, as the hospital, every single negotiated rate that you have with every payer, down to the plan that you have, HMO, PPO, etc, or gold, silver, bronze, and you've got to do your cash rates and your list price.’ Think of that list price as the equivalent of the MSRP on a car, that high starting price that most people usually don't end up paying. The cash price was usually a discount off of that and then the negotiated rate was its own separate thing with an insurance company. So, in posting all these rates, that nullified all the gag clauses and all the non-disclosure agreements all at once."
• 25:23 - More regulation will turn healthcare into a marketplace : “In the 70s the airline industry was heavily regulated. Normal people didn't get on planes, planes were incredibly expensive, there were pianos on the 747, it was a whole different world of airline travel. Once it was deregulated, you started getting other players in the market, like Southwest and others, that started jumping in and driving down prices. I used to have to call a travel agent to get prices, and then they could, frankly, be like, ‘Where are you on the income threshold, and how much margin can I throw into this ticket?’ Whereas now it's so competitive, you type into anything, Google Flights, Kayak, etc, and you're going to get a clear rate, you know exactly what the price is, and you can match it against every other flight. Everyone's had to get more competitive and the industry, in many ways, has gotten better and more democratic and more accessible. I think that's actually the best example of where healthcare could go in the long run, in the sense that, ironically, you're doing it with regulation that actually forces marketplace forces into the industry, which is a really unique use case. Usually you deregulate here, but ironically, you're actually adding more rules to make it more of a marketplace.”
• 34:48 - Price transparency is a bipartisan issue: “Trump was the first administration that actually pushed these rules through, fundamentally, regardless of one's political beliefs, this was Trump's initiative. He got this started, price transparency. So, it was the Trump administration, their CMS initially established the rules for hospitals and payers to post their rates. And then in, a rare act of bipartisanship, Biden's administration came in, they absolutely agreed with it, and then they actually increased the penalties for hospitals versus what the Trump administration did, and then they actually started to do as much aggressive enforcement as they could at that time. What I'm seeing thus far in both Trump appointees, as well as the new Congress that's just come in, like representative Buddy Carter is the new chair of the Subcommittee on Health in the US House of Representatives, and one of his first things he said in a press release was literally, ‘as a former pharmacist, I care about PBM reform with pharmacy benefit managers. I care about price transparency. Those are going to be things that are top of mind for me.’ We're seeing a similar thing even with Dr Oz in some of his preliminary conversations, talking about how price transparency is a top initiative for him and doubling down on price transparency. So, I do think you're going to see a continuation of these policies and another round of doubling down; just as Biden doubled down, I think the new Trump administration, regardless of who's in, Dr. Oz, RFK, they get replaced, someone else comes in, because this was Trump's idea, or at least Trump pushed the original version, the theme is going to stay the same."
• 38:14 - Federal vs state transparency enforcement: "On the hospital side, enforcement's done by the federal government, by CMS, but on the payer side, for the massive insurance files that United has to post, or Cigna, Aetna, etc, CMS wrote the rules, but it's the states that are the first line of defense for enforcement. So, instead of herding one cat, you're herding 50, and do you really think, no offense to Wyoming, but Wyoming doesn't have the government resources to mine these files, like, say, a California might or a Texas or a Florida. So, that's added an extra layer of confusion on what's called transparency and coverage for the payers. There hasn’t been enforcement yet because there's confusion on who actually does the enforcement, and each state is figuring that out in their own journey, and that adds quite a bit of confusion to the process.”
• 41:32 - Working in the public sector: “Right now, there's so much shifting in healthcare, I'm really committed to working through this problem and dedicating a ton of time to it through Turquoise, and with Turquoise as a company, until we can make as big of an impact as possible. I'm going to go wherever I have the most impact and, right now, this is such a niche thing that I'm in this really fortunate position that I can go on the Hill and follow up on a lot of the really public discussions. You've got even rappers like Fat Joe and the Foo Fighters engaged in this topic, like it's a really interesting coalition of people that's been built around pricing transparency. Those are names I never would expect to see in this and it's awesome to follow up a lot of that massive public momentum, and get in a room and then talk nuance and detail. I'm like, ‘Okay, we all agree this is a thing. Bernie Sanders agrees on this, Trump agrees on this, Republican senators agree on this. How do we actually make it happen now and make it practical?’ And that's where my really unique background helps fit the moment for us. So, I'm going to keep doing this and go where I'm going to have the most impact. And that might mean shifting out of the private sector one day too.”
• 44:09 - Can DOGE provide some efficiency?: “I look at pricing transparency as a very effective way to hopefully, in the long term, ideally have prices converge and ultimately lower. You can't have healthcare increasing at the rate it is today, infinitely. It will mathematically become impossible to afford healthcare if it keeps going up the way it is. And I'm like, great, this is a win. But then I'm talking with the Congressional Budget Office, and we're realizing with CBO, oh, they won't count this as savings, because it's not Congress doing it, it was the Trump administration through their rule. So when everyone was trying to figure out that spending bill and to try to lower government debt. In the long run, no one could count pricing transparency, because it wasn't Congress's thing. So you even have an accountability fight behind the scenes of government legalese, again, devil in the details. So, these are all things that Doge is going to have to sift through. And the awkward reality is that our debt, the interest that we pay on our debt, and the money that's assigned to Medicare and Social Security, that is overwhelmingly what we spend money on, and that's going to be difficult. So, any attempts for government efficiency always sound excellent on paper, but when you run into some of these realities, it doesn't mean it's less worthwhile, I think about, how do you maximize every dollar? Absolutely nothing wrong with that. But I just don't think it's going to be very simple for sure.”