 |
||||||||||||||||
    |
||||||||||||||||
Chairman's Message "To sleep, perchance to dream ... " If you have been waking at 3 a.m. suffering from all kinds of torments regarding global warming, the dollar's exchange rate, and other issues of the day, I suspect you are not alone. One of my big pre-dawn musings and a perpetual healthcare "issue of the day" is achieving transparency and eliminating spin. So, here are some thoughts gathered in the wee, small hours. Roger PayneTransparency in Healthcare: But when it comes to healthcare, consumers aren't so lucky–standardized, quality data aren't readily available. Fortunately, this is changing. The healthcare industry has begun to respond to consumers' demand for more informed choices about their healthcare through the concept of transparency. And while transparency is a powerful idea, it's subject to many different interpretations. Simply put, transparency means making information available to consumers that previously was not available to them. This may include prices for common health care services with a specific physician, as well as clinical quality and efficiency information on physicians. Transparency also means the opportunity to change public perception of your institution, and ultimately, the quality of care it delivers. I want to share with you why that is. Transparency in healthcare is not new–since the mid-80s, health policy experts have advised administrators of corporate healthcare plans to consider cost and quality data. On the other hand, consumers' demand for quality data seems driven by the availability of online information in all facets of their lives. Consumers now expect to be able to find reliable, standardized comparative performance data for healthcare providers, procedures, and policies. The national Blue Cross Blue Shield Association (BCBSA) undertook an interesting study in November, 2006, in which it surveyed 1,600 people. Almost 88 percent of respondents declared that, if diagnosed with a medical condition, they would search online for information about treatment options. Eighty-one percent said they would search for information about physicians or hospitals that could provide treatment. And when it comes to choosing a hospital or clinic, quality information ranks highest in importance to those surveyed. So what's a provider or hospital to do? Today's hospitals face many challenges with effectively reporting cost and quality data to the public. One clear–and convenient–option is to collaborate with payors in hopes of leveraging their existing claims data sets. However, that presents senior hospital executives with the challenge of putting the payor in charge of driving quality. That may be dangerous, given that most insurers may focus more on reimbursement than on the daily needs of a given provider, as seen in the push by payors toward a "pay-for-performance" model of reimbursement. This can be a challenge for hospitals and providers when it's interpreted as the insurer "directing" care. It can also appear to patients that the insurer is limiting certain procedures by not offering an incentive for performing them. Pay-for-performance programs can work to the benefit of providers when they allow doctors and hospitals to find and use their own solutions for meeting performance-improvement goals. But pay-for-performance is only one way to obtain and present standardized quality data to the consumer. For example, Massachusetts' pioneering collaboration, Massachusetts Health Quality Partners (MHQP) mines National Commission on Quality Assurance (NCQA) data for both medical groups and specific treatment areas. Further, the Joint Commission has an extensive website of tools that providers could make use of. Simply by adding link to their corporate website, and promoting to these free-of-charge tools to their patients, providers can quickly and easily make quality information accessible. Apart from existing transparency tools for consumers, senior hospital leaders have justifiable concerns about additional aspects of transparency. MHQP offers medical group care data, but not hospital quality ratings. Many state health departments conduct reporting on care-intensive chronic conditions such as heart disease, but not on others. These concerns are valid, and tie into the need for standardized quality data across the spectrum of care. It's equally important to address the idea of cost of care, not just quality. While the BCBSA report finds that more than half of all consumers are seeking pricing information when selecting a provider, they rank several other types of information as being more important than cost when selecting a PCP, specialist, hospital or treatment option. Does that mean that cost is not part of the drive toward transparency? No. Pricing data still has value, but it remains to be seen when and whether healthcare providers will be able to assess and present cost in valid terms. In theory, pricing transparency will increase competition and make it easier for consumers to make important healthcare decisions. But several studies have shown that hospitals and physician groups are not prepared to deliver pricing information directly to consumers for two key reasons: they often do not know their costs per service, and most healthcare is purchased not by consumers directly, but by insurers. Ultimately, the drive toward transparency presents far more benefits than challenges. Giving consumers the information to make better-informed decisions is the right thing to do. Healthcare leaders are wise to embrace and endorse existing transparency tools, and to encourage the development of quality initiatives and data that work for everyone.
|
||||||||||||||||
|
||||||||||||||||
SIGN UP to receive future newsletters
