Making sense of rapid industry changes
The healthcare talking heads are predicting the demise of insurance companies as a result of direct contracting, the consolidation of hospitals into five or six giant health systems and other radical changes—all stemming from the Patient Protection and Accountable Care Act. We’ll see if those massive disruptions will happen in the future. But real changes are already taking place in the relationship between hospitals and employers. I think they are for the better.
At Truven Health Analytics, the only independent healthcare information company serving all major sectors of the industry, we are actively integrating this combined experience, data and knowledge to address the realities of the ACA.
The often-contentious relationship between employers and providers is shifting to one with common goals for community health. Employers are realizing that quality is not a commodity. Hospital and health system executives are realizing that they are now sellers who must demonstrate their value—not just talk about it. The traditional antagonistic relationship focused on cost alone is shifting into a collaboration to define goals for increasing value and improving population health. This new collaboration requires a common language, common goals and common data. And it generates a common need for new transparency and better metrics. But the government has not caught up with these needs.
While the ACA requires greater transparency, the law fails to address the inadequacy of public data and metrics to support effective public reporting of quality across settings, as well as prices. And little has been done to separate the need for provider metrics that help patients make informed decisions from the need to demonstrate consistent performance improvement. The first is disease- and procedure-oriented. The second is critical to employers and payers that need effective and reliable business partners that can achieve mutual goals.
It is time to address those inadequacies and improve public data sets to meet evolving public needs. It is also time to clarify what needs to be measured, why and for whom. In the meantime, the private sector is beginning to take action. The cost of doing nothing is too high. The business needs of employers and providers will drive timely development of better metrics from new, integrated data sets for monitoring and achieving mutual business goals.