Curing health care calls for transparency and collaboration

Most people wouldn’t buy a car or even a pair of shoes without knowing the price and how the product compares to other, similar products. Yet, when it comes to health care, people make decisions for themselves and their family members every day without fully understanding the implications of those decisions.

Consider the employee who enrolls in an employer-sponsored health plan without understanding what their cost-sharing responsibility will be. Or the patient newly diagnosed with diabetes who does not ask their primary care physician about the diabetes program and outcomes at his or her clinic. And furthermore, the individual who is managing their personal health care needs along with those of their children and aging parents. In any and all of these situations, people are making important decisions based on incomplete data about themselves and their physicians.

With health care, as in many other areas of life, information equals knowledge, and knowledge equals power. Access to information ultimately comes from greater transparency, or sharing of data by health plans and health care providers. In our work at the Buyers Health Care Action Group (BHCAG), we participate in and observe health care reform on both a regional and national level, and are reminded at every turn of the need for greater transparency in all things related to health care.

We believe that in order for real change to occur, the general public and the business community need to have a voice in the debate, and they need access to information and data that can influence the decisions they make about how they purchase health care coverage and services. These essential conversations cannot happen behind closed doors.

Minnesota has historically been at the forefront of change in health care, thanks to the innovative spirit of the health care community, the collaborative nature of our employer base, and the expertise of the medical community. Minnesota has already made great strides in data transparency and serves as a model for national change in many areas. However, we need to continue to work together and push to make more meaningful data available to employers and individual purchasers. The availability and understanding of health care data will contribute to positive health care reform in several key categories, including:

• Improving quality of care and outcomes. Current health care reform calls for improved outcomes and emphasizes pay-for-performance programs and value-based benefit design as a way to reign in spending and create a more sustainable reimbursement system. The Minnesota Bridges to Excellence program, implemented in 2006, was one of the nation’s first employer-led, pay-for-performance programs designed to improve and report on outcomes, at both the clinic and medical system level, for people with diabetes, heart and vascular disease, and depression. By pushing for direct data reporting at the clinic level rather than the system level, health care consumers gain a better understanding of the quality of care and outcomes delivered by individual clinics in different communities.
  
  By accelerating the use of direct data reporting at the clinic level, BHCAG has encouraged greater use of transparency tools across the entire community. In addition, the Bridges to Excellence program has been a driving force behind a shift from process reporting by health care providers to performance reporting. In other words, reporting on the outcomes of the procedures or care that is delivered instead of merely whether something was or was not done.
  
  
• Patient safety. Closely related to the issue of quality is patient safety. BHCAG worked closely with Minnesota employers to help pass legislation in 2003 that required Minnesota hospitals to report on adverse events or medical mistakes, as identified by the National Quality Forum. As a result, Minnesota was the first state to adopt all of the National Quality Forum’s 27 adverse events by legislative action. The push for reporting of outcomes continues through Aligning Forces for Quality (AF4Q), a grant from the Robert Wood Johnson Foundation. AF4Q grants were awarded in 14 communities, including the metro area, with the common goal of aligning provider performance, public reporting and quality improvement.
  
  BHCAG is actively involved in AF4Q and efforts to increase use of the Minnesota Community Measurement Web site as a common source for data. In addition, we are part of a workgroup that has developed http://www.theD5.org, a web site for people with diabetes to help them understand the common diabetes measurements, why they’re important and how local clinics perform against these measures.
  
  
• Health plan performance and accountability. Health plans are at the center of the health care debate, as businesses and individuals are reeling from year after year premium increases and millions of Americans remain uninsured. We have worked steadily with employers and health plans as a founding member of eValue8, a health plan survey tool, to make public information about health plan cost, quality and performance in eight key areas.
  
  
• Personal health information. Giving individual patients access to and control of their own health information, including medical history, test results, coverage limitations and financial information, is key to creating more informed and engaged health care consumers. And, it could be a critical component to how people experience health care in the future. BHCAG believes that personal health information should belong to the individual and should not be tethered to a health plan or provider system. To this end, we continue to advocate for businesses and health care companies to adopt myHealthfolio, a Web-based public health record that is owned by the individual, regardless of where they receive care or who their insurance carrier is.

In the coming months, we will continue to advocate for increased transparency and meaningful change in the availability of data and how employers and individual consumers access health care information. I encourage you to share your thoughts and comments with me via this blog. A healthy dialog is a first step to creating change in the marketplace.

In the spirit of healthy change,

Carolyn Pare

President & CEO