Health care deal sites --I'm quoted and I'm skeptical

DealWell, a new company  that offers online health care deals, is the subject of a story on KERA, the NPR station in Dallas. I'm quoted in the audio and text versions.Like other sites, the health care deals on DealWell tend toward ancillary services that aren't typically covered by health insurance: dentistry, LASIK, massage, etc. You can also find some medical imaging and weight loss surgery.I'm all for health care shopping and transparency, but I'm not a big fan of these sites and I don't expect them to have a major impact on mainstream health care. (On the radio I refer to DealWell as "a little sleazy," although the CEO disagrees!) Here are some of the problems:

• DealWell uses a Priceline-like mechanism: accept the price posted on the site or bid less and see if your bid is accepted. This is a clever feature, but think about how it impacts trust. If I can't trust my doctors to tell me the real price of the service upfront, why should I trust them about anything else, like whether I need a service in the first place?
• Providers who offer these deals are paying DealWell in addition to offering cut-rate prices. Presumably they would like to make back their investment. The price-based shoppers on these sites are likely to go to a different deal-making dentist next time, so a tempting way to make real money is to recommend services that may or may not be needed. Even the initial packages that are offered may be more comprehensive than needed. Dental deals typically include teeth cleaning, a full set of x-rays and oral exam. Not everyone needs all that
• These deal sites do not integrate with insurance.  The first patient cited in the article got an MRI for $400 on DealWell when she'd paid over $1000 before. But who is paying for MRIs out of pocket these days? Even with a high deductible plan it would make sense to shop around within network rather than going outside of insurance and paying cash. And if the plan doesn't approve the MRI or ultrasound it's probably because it's not medically necessary
• Continuity of care is eroded when patients see different providers every time

I can envision a limited role for these sites for patients who need services outside of the traditional medical system. But the big strides on health care transparency and affordability are being made today within the context of the Affordable Care Act and with transparency companies such as Castlight.