“Data Liberacion!” “Free the Data!” “Transparency or Bust!”
If all of the organizations working on controlling health care costs were to hold a rally to push for a better system, it’s likely many would be carrying (or wearing) signs saying all of the above. But what do we mean when we say we want transparency in health care?
Existing Transparency Efforts
More health care data is available now than ever before. Medicare provides loads of data publicly regarding payments, and there are national databases with commercial claims information. Colorado has the Colorado All Payer Claims Database (CO APCD), Colorado Health Access Survey, Colorado Health and Environmental Data, Colorado Hospital Price Report, and countless other publicly available resources that point to some aspect of costs. Why, then, are premiums continuing to rise when so much information already exists?
Transparent Statewide Claims Data
CIVHC can’t speak directly to the intent of all of the health data resources in Colorado, but the CO APCD was specifically intended to identify opportunities to reduce costs and understand variation in how Coloradans are paying for care, among other things. We work to publish actionable information to help consumers become informed shoppers, and communities and other Change Agents identify price disparity opportunities regionally and across counties.
With every website update and Spot Analysis we issue, we’re releasing more and more insights on price variation and targeted ways Colorado can address the Triple Aim of better health, better care and lower costs. For example, reducing unnecessary Emergency Room visits could save the state $800 million, reducing C-section rates by 10% could save $6.5 million annually, and we have demonstrated plenty of opportunities to reduce price variation for high cost, high volume services across the state.
Our goal for publicly reporting data is to provide enough information in a user-friendly way that is useful, but not overwhelming. As consumers, we are constantly inundated with information and data – through our smart phones, social media platforms, news and media. It is human nature to start ignoring data and information when there is too much and it’s difficult to weed through tons of information to get answers. CIVHC tries to balance having enough data to be meaningful to a wide variety of audiences with varying levels of data sophistication without overwhelming the user with data overload.
Transparency for Consumers
CIVHC believes that consumers should be equipped with easy to use, transparent price and quality information and that consumers can and should play a role in pushing the system towards higher value based on the decisions they make. However, even with high deductible plans becoming more the norm than the exception, in the current landscape, it would take decades for providers to voluntarily reduce their prices and negotiated rates with health plans based on consumer decision-making alone. There simply is not enough of a critical mass of consumers who are actively shopping for care in order for it to impact facilities and providers so much that they would be willing to reduce what they get paid independent of other influences.
Until we reach that tipping point, CIVHC will continue to enhance named provider quality and price reporting with the intent that it can be used as a tool to educate consumers that price variation exists, that the decisions they make have an impact on their annual premiums, and encourage shopping for care when possible.
We are hard at work expanding how we report facility cost and quality information and are looking forward to sharing new reports in the New Year. We find this part of our work to provide consumers with price and quality information very important, yet we know that alone, it isn’t enough to reduce rising costs.
Transparency for Employers, Payers and Providers
Lessons learned from other states indicate that the biggest short-term benefit from providing transparent price information comes from providers seeing their prices in comparison to their peers for the first time, and large employers and health plans changing the way they incentivize employees and members through benefit design. Colorado PERA is one such employer in our state that has saved over $580,000 in costs in just 18 months (with only 48 cases) for encouraging employees to go to high value providers for knee and hip replacements. Patients who participate in the program are rewarded by not having to pay any money out of pocket for what is typically thousands of dollars in copays and deductibles (up to $12,000).
The CO APCD helps inform employers and providers setting up these new benefit design programs by providing median “allowed amounts” collected in the claims. Allowed amounts are the prices that insurance companies and consumers (in the form of copays, etc.) pay providers for services. This helps identify which entities are getting paid more than others for the same services. That data coupled with quality and outcomes information helps employers and health plans identify which high value providers to partner with and which providers to steer employees towards.
Missing Data to Complete the Puzzle
Locally and nationally, there is a key piece of the transparency puzzle that is missing: understanding why costs vary so much, and how much it actually costs providers, health insurance companies, pharmaceutical companies, and other vital players to provide care and services. Better understanding of profit margins would help identify when payment and cost variation is warranted based on location and other factors and where it might be out of balance, and what solutions might exist. Without knowing more about actual costs that are incurred in the system, it’s difficult to close the gap on variation without potentially sacrificing the vitality of providers and other businesses who serve a crucial role in our health care system.
Data Without Action Is Just Numbers
Information available publicly or on a custom request basis, whether through the CO APCD or other sources, provides a resource for identifying needs and generating potential solutions. However, change can’t and won’t occur independent of community activation and engagement – whether that be in the form of consumers, policy makers, providers, health alliances, health payers, or others.
The Institute for Healthcare Improvement (IHI) identifies three key components to positive change in the health care system: Will, Ideas, and Execution. The WILL to change must exist first, IDEAS must be developed that can impact the status quo, and those ideas must get EXECUTED in order for change to occur. Transparent CO APCD data, whether public or custom, provides information that can stimulate and inform the IDEA phase and measure the impact of the EXECUTION phase. Not surprisingly, IHI identifies execution as the hardest part which takes leadership, resources and dedication in order to make lasting improvements.
Continued Commitment
As part of CIVHC’s mission to support Change Agents advancing the Triple Aim of better health, better care, and lower costs, we will continue to enhance the public and non-public data we provide from the CO APCD. We recognize that data alone, no matter how much we provide or the manner in which we provide it, will never be a magic bullet to reduce costs. Nevertheless, we are proud to provide analyses from the CO APCD to those we serve as it can be and has been instrumental in helping consumers and communities identify a starting point upon which to act.