Looking Through Health Care Transparency

By Sander Domaszewicz

Dec. 20, 2007

We’ve come a long way in terms of providing more and better health care information to employees. As health care deductibles and co-payments have risen for the U.S. workforce, so have efforts to promote more enlightened health care choices and consumerist options—from incentive programs to health savings and reimbursement accounts and a growing range of resources for more cost-efficient health. At the same time, pressure has mounted on health care providers to make their cost data more transparent in the marketplace.

    But health care will always be more than a commodity to be purchased and consumed on a best-price basis. Instead, it will remain a complicated value proposition in which cost and quality factors must be weighed carefully. And that’s still not very easy for most people to do, despite rising consumer demand for transparency from payers, providers and pharmacy benefit managers. The fact that they are sharing more information on the cost of tests, treatments and drugs only underscores the need to make that information more meaningful to the consumer.

    Fortunately, the forces for meaningful health care transparency have been gathering positive momentum in recent years. An executive order from President Bush directed U.S. government agencies responsible for health care programs to release price and quality-of-care information. And Department of Health and Human Services Secretary Mike Leavitt has asked major employers, state governments and other large health care purchasers to embrace health information technology, share their health plan quality and cost information, and insist that providers adopt quality and cost measurement standards.

    Meanwhile, the federal Center for Medicare and Medicaid Services, the nation’s single largest health purchaser, and the U.S. Department of Health & Human Services have been releasing cost and provider-quality data, which can be accessed online at CMS’ Consumer Initiatives section and HHS’ Hospital Compare site State government initiatives, such as New Hampshire’s mandate that health insurers provide data on health care costs by facility and procedure and then post that data online, are swelling the tide. Indeed, the traditional provider’s argument—that health services quality in relation to cost can’t really be measured—is eroding under the weight of available data. This is enhanced by the efforts of lobbying groups such as the National Business Group on Health, and the emergence of organizations such as the Leapfrog Group, whose membership comprises some of the largest health care purchasers in the nation and which encourages health providers to publicly report on quality outcomes to advance the cause of informed health care consumerism.

    Importantly, the private sector is stepping up to the plate. Mercer’s original 2004 initiative, called Care Focused Purchasing, has led more than 50 large employers to pool their data and develop a scorecard system that rates health care providers on quality and cost efficiency, with a goal of developing a rating system based on treatment standards and consumer experiences. Mercer’s U.S. health care thought leader, Arnold Milstein, M.D., a Leapfrog Group co-founder and the medical director of the Pacific Business Group on Health, the largest employer health care purchasing coalition in the U.S., has called for the use of Medicare and Medicaid data as a public asset to help raise the efficiency bar for all providers.

    If there’s a disconnect, though, it may well be that awareness and usage of the information remain low, largely because it’s still problematic for consumers to marshal all of the cost and quality data that is becoming available. Comparative health information is not a “build it and they will come” endeavor. It requires significant marketing to get out the word on ease of use and value of the information to the public. It also requires data consistency that standardizes quality and efficiency measurement, avoiding confusion by relying only on nationally recognized and vetted measures that can be understood by the average consumer.

    People not only have to be aware information is available, but also must clearly see “what’s in it for me” and for their loved ones. The consumerist trend encourages everyday folks, not just M.D.s and Ph.D.s, to consider all dimensions of health care value more carefully—and, fortunately, more of them are searching out, demanding and finding the best quality and health outcomes at a reasonable cost and with acceptable levels of service.

    Yet as far as health care transparency has come, it still has a long way to go. And if the polls of health information users and consumer plan enrollees hold true, the more information people get, the more they’ll want and demand. Faster, easier to use, more accurate, more reliable and timely, and so on. We may never be done in this regard, and that’s fine. Greater demand will open up the capital required to create truly intuitive solutions. The foundation technology—led by the near-universal accessibility of the Internet—is certainly in place, but at this point, the various points of contact remain scattered. How many health care consumers, for example, know that the Leapfrog Group providesquick online information on hospital quality and patient safety:  by city, state or ZIP code?

    And that will remain the larger challenge: making consumers aware that such information is being codified and is out there for them, that it’s easy to find and important for them to use. An obvious analogy relates to the price of oil. Knowing the cost per barrel at any given time doesn’t really help the consumer, but the emergence of Internet sites listing comparative gasoline prices at local stations has made it easier for us to make better choices at the pump.

    Health care cost and quality information is much more complicated, of course, and so much raw data is entering the pipeline from different sources we must not overlook the ultimate purpose of that data—to serve us, for we are all health care consumers, and to make our choices clearer and our lives better.

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