Creating Transparency, One Step at a Time

Greater transparency across all stakeholders is necessary to transform our healthcare system. Providers need transparency around the rules by which they are paid so they can understand what influences their reimbursements. Payers need transparency into providers’ clinical outcomes so they can pay providers appropriately. Patients need easy-to-understand, comparative provider data in order to decide to whom they should entrust their care.

Transparency helps build the trust that is vital to better collaboration among all of healthcare’ s stakeholders. Without trust, it is exceedingly difficult for each stakeholder to understand that the others share its goal of high quality care at an appropriate price, that each has a role in achieving this goal, and that if we could just work together, we could make progress on healthcare reform.

To increase their value proposition in a changing marketplace, payers have been looking closely at the care process and wrapping services around it. The idea is to become a valued healthcare advisor by, among other things, collecting and disseminating the type of information that helps providers to deliver better care and consumers to make better healthcare decisions; for example, providing preventive, diagnostic, and treatment options for a disease, or highlighting practice patterns that are not aligned with evidence-based medicine.

Payers have the ability to play the role of healthcare advisor. However, because they control the reimbursements in addition to collecting healthcare data, their challenge is being credible in that role. This will require the trust of the other stakeholders. Without trust, care processes cannot be connected and we cannot achieve economic alignment between stakeholders. Can we transform the healthcare system through increasing transparency, or will this be yet another ” trend” that fails to deliver on its promise?

Supporting Technology

Before we can achieve transparency in the healthcare system, we need a technology infrastructure that supports connectivity and interoperability across healthcare stakeholders. However, moving data from place to place is not enough. We also need tools that translate the data into actionable information that will impact outcomes as well as the quality and the cost of care. The shared information must be given business and clinical context, and must move as freely as possible to the person who needs it at the given point in time, translated into the language that he or she understands best.

Where are we now with technology? Though payers, providers and other healthcare stakeholders (e.g. pharmacies and labs) have databases full of valuable patient information, the databases do not interoperate. If those data sources could communicate, the information they contain could be leveraged to identify patients much earlier in their diseases, allowing them to be connected to the care management system that can best manage their health.

Consumer Impact

Greater transparency in healthcare will have a tremendous impact on consumers. Today, if you want to buy a car or a television, you can find out a vast amount of information beyond its simple features, including other consumers’ thoughts about a product’ s pros and cons. This doesn’ t translate to today’ s healthcare industry. For example, how do you find the best physician to perform an appendectomy? If someone recommends Dr. Smith, how do you know how many appendectomies she has performed, or what type of complications her patients have experienced?

Studies have shown that consumer engagement is directly proportional to the amount of information available to them. An example is the automobile industry: the more information that the public has on certain weaknesses in a car, the more the manufacturers work to eliminate those weaknesses. We have new safety features, such as side airbags and electronic stability control. Hybrid vehicles are being produced because consumers want to lessen their environmental impact. Performance and safety have both been enhanced by the competition that transparency puts into place.

Going back to the appendectomy example, imagine that you can look up information on the providers in your area. You have a choice of two hospitals, located equally close to you. One has an infection rate of 10 percent, the other 1 percent. Obviously, you would go to the latter, which would eventually drive the poorer performing hospital to improve.

Often, the argument is put forth that healthcare is too complex for market-based principles to apply. However, many transparency efforts are quite simple and can be taken one step at a time, which many organizations are doing.

Moving Forward

I have always believed that health plans, rather than industry consortiums or other groups, are in the best position to drive transparency forward. They have the most comprehensive information about the care we all receive and are in the best position to share it with other stakeholders. In addition, we often lose sight that health plans have been great innovators over the past 20 or 30 years, inventing new products and programs such as HMOs, PPOs, consumer-directed options, disease management and pay-for-performance.

Undoubtedly, as the transparency movement gathers momentum, it will be met with resistance. However, overcoming this challenge is quite simple: 1) Involve the major stakeholders you are measuring and reporting on in the process; 2) Select the high-level metrics that you are going to make transparent and tell those you are measuring what you plan to do, giving them time to put systems in place to ensure they perform well on those metrics; and, 3) Share the data with them for a certain period before you share it with anyone else, so they have time to make appropriate adjustments.

Allowing a transparency initiative to be opt-in in the beginning also helps. Eventually, the few will become the many.

Good judgment and integrity must be exercised in the process. Data must be useful to the various stakeholders who receive it, and it should not be used for an individual entity’ s gain, nor provided without context. For example, if one hospital’ s complication rate for cardiac surgery is 50 percent higher than another’ s because that hospital sees significantly more severe cases, it would be unfair to simply report the higher rate without explaining to the consumer why it may be higher. Similarly, if it takes longer to be seen in an urban emergency room versus a small town ED, the consumer must be made to understand that one hospital might have a busier trauma center because of its location, which might delay how quickly a patient is seen for less severe conditions.

Transformative Steps

As I travel across the country and talk with various healthcare organizations, both public and private, I see stakeholders taking one of two approaches to transparency. First, there are those who are waiting for a big policy mandate, as this tends to force forward movement in areas where consensus has been difficult to build. Second, I see that quite a bit of progress has been made at the local level, by organizations that clearly understand the importance of simply getting started, then refining their initiatives over time. Often in healthcare, we slow our progress because we think we cannot drink the water before we boil the ocean. However, these organizations are taking small but transformative steps toward a new era of openness and collaboration.