Health care transparency and the value equation

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Health care transparency and the value equation

When we are in the doctor’s office, we all want the highest quality of care. While quality is obviously a very high priority, it isn’t the only thing that matters when making a decision about health care. A better way to think about it is the value of the health care service. If someone receives unnecessary care, even if it’s high-quality, we’ve exposed that person to potential harm as well as increased financial burden.

There are six things to consider when evaluating the overall value of a health care service:

  • Appropriateness: Is it really needed?
  • Process quality: Is it provided in the most effective and safe manner?
  • Price: Is it produced at a fair price for the buyer?
  • Outcomes: Is it producing the best possible results for the patient?
  • Intensity: Is it provided in the most efficient manner?
  • Experience: Is it provided in a patient-centered way?

The Alliance has ongoing efforts to promote measurement and transparency in all six of these areas. Our Alliance’s flagship reporting effort, the Community Checkup, has differentiated Washington state as a leader in quality transparency nationwide. In 2014, the Alliance partnered with the Washington State Health Care Authority to get broad stakeholder agreement upon a statewide measure set on health care quality and cost, which both commercial and Medicaid payers will be encouraged to use to inform purchasing and to drive quality improvement. But when it comes to understanding the cost of health care, there is still much work to be done to improve price transparency.

Improving the value of health care is complex and challenging. It requires a focus on all the variables of health care value—not just quality. It’s important to align expectations, including specific measures of performance, so providers can work together toward common goals. Transparency needs to be designed for different users and it should be presented in such a way that it aids decision-making. Purchasers and consumers have different needs than providers.

Support for provider organizations is also important, particularly for smaller organizations that don’t necessarily have the time or resources to orchestrate improvement initiatives. And finally, you can’t talk about health care without talking about incentives. For too long, we have rewarded many of the wrong things, most notably volume. The way we pay for care is shaping the behavior of the delivery system. We need to move toward more efficient and effective care.

While we at the Alliance focus a lot on transparency, by itself, it won’t effectively drive better performance and lower costs. But, it is a critical tool for identifying, understanding and ultimately reducing unwarranted variation in health care utilization and price.

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