Trans­parency alone is not the sil­ver bul­let

Modern Healthcare - - Q & A -

“No­body else has the ro­bustly large data set we have to es­ti­mate prices as ac­cu­rately as we will be able to es­ti­mate them.”

David New­man is ex­ec­u­tive di­rec­tor of the Wash­ing­ton-based Health Care Cost In­sti­tute. The or­ga­ni­za­tion’s mis­sion is to foster bet­ter un­der­stand­ing of the driv­ers of health­care costs and to pro­vide a data­base on pub­lic- and pri­vate-sec­tor costs and qual­ity. Prior to join­ing the in­sti­tute, New­man worked at the Con­gres­sional Re­search Ser­vice and served as a con­sul­tant to the CMS, the Food and Drug Ad­min­is­tra­tion, HHS and other gov­ern­ment agen­cies. Mod­ern Health­care re­porter Dar­ius Tahir re­cently spoke with New­man about the in­sti­tute’s new trans­parency project for con­sumers. This is an edited tran­script.

Mod­ern Health­care: Please de­scribe your in­sti­tute’s part­ner­ship with in­sur­ers to cre­ate on­line trans­parency tools for con­sumers.

David New­man: We are work­ing with Aetna, Hu­mana, Unit­edHealth Group, As­sur­ant Health, Har­vard Pilgrim Health Care, Health Net, Kaiser Per­ma­nente, Part­ners Health­Care and the Na­tional Com­mit­tee for Qual­ity As­sur­ance to de­velop con­sumer trans­parency and pub­lic re­port­ing stan­dards for cap­i­tated, in­te­grated and value-based plan de­signs.

His­tor­i­cally, we have done very tech­ni­cal re­ports for wonks on cost and uti­liza­tion trends. We held well over 10 bil­lion claim lines from in­sur­ers with the ac­tual amounts paid for ser­vices. We wanted to broaden the mis­sion and have a more pub­lic-fac­ing fo­cus on trans­parency.

MH: How is that ini­tia­tive pro­gress­ing?

New­man: As we reach out more broadly to in­sur­ers, we get dif­fer­ent re­ac­tions. One is, “This is re­ally help­ful—we’d like to par­tic­i­pate across the board.” Other play­ers look at the price trans­parency ini­tia­tive and say, “We’re mov­ing to­ward in­te­grated de­liv­ery and bun­dled pay­ment and we think you need trans­parency that’s ap­pli­ca­ble to th­ese mod­els.” We want to de­velop mod­els of ap­pro­pri­ate price and qual­ity trans­parency for in­te­grated de­liv­ery sys­tems and bring those play­ers into the larger trans­parency ini­tia­tive. We also want to save states and other or­ga­ni­za­tions some of that ef­fort by putting out sug­gested stan­dards.

MH: Many groups are work­ing on price trans­parency. What is your or­ga­ni­za­tion of­fer­ing that’s dis­tinc­tive?

New­man: We’re not try­ing to cre­ate a business model and com­mer­cial­ize health­care data. As a non­profit, this is a non­com­mer­cial ac­tiv­ity to pro­vide in­de­pen­dent, ob­jec­tive price and qual­ity in­for­ma­tion to con­sumers. No­body else out there has the ro­bustly large data set we have to es­ti­mate prices as ac­cu­rately as we will be able to es­ti­mate them. We cur­rently hold data on over 50 mil­lion Americans. We hope to set the stan­dard in the trans­parency space by be­ing the most trans­par­ent.

MH: How will your trans­parency tools work?

New­man: We’ll of­fer a pub­lic web­site called Tier 1. If you are an unin­sured per­son, you can get an av­er­age price across an ar­ray of ser­vices in a ge­o­graphic area. If your kid has an up­per-res­pi­ra­tory tract in­fec­tion, you put in your ZIP code. What we’ll put up there is the av­er­age price for that bun­dle of ser­vices, and a mea­sure of the vari­ance in prices within that ge­og­ra­phy. This will be free, with no user reg­is­tra­tion or pass­word. News re­porters can look across ge­o­graphic lo­ca­tions. You can map states. I don’t be­lieve any­body is cur­rently do­ing this on a na­tional level, with thick data for a free ser­vice.

In Tier 2, peo­ple whose in­surer is par­tic­i­pat­ing in the ini­tia­tive will re­ceive a user ID and a pass­word. When they log in, the web­site will as­sess where they are with their de­ductible. It will know what their plan de­sign is and who their net­work providers are. It will be able to give them price and qual­ity in­for­ma­tion that’s spe­cific to their plan de­sign. At this point, it looks sim­i­lar to in­sur­ers’ ex­ist­ing web­sites. But none of those web­sites are get­ting mas­sive trac­tion. Peo­ple’s em­ploy­ers may change car­ri­ers from year to year, so each year the em­ploy­ees have to find the new web­site. By cre­at­ing a crossin­dus­try por­tal, all in­sur­ers will be pro­mot­ing a sin­gle web­site for con­sumers to go to, and we hope con­sumers will use this web­site far more of­ten.

MH: That sounds like a real chal­lenge tech­ni­cally.

New­man: Tier 1 is a pretty easy lift. We al­ready hold all the data. We know the care paths, the episodes of care and the im­por­tant CPT codes. Tier 2 is far more com­pli­cated. Each in­surance company al­ready has this type of web­site, so they have ex­per­tise in-house and can help us. But when you move to a cross-payer por­tal, it’s more com­pli­cated be­cause dif­fer­ent com­pa­nies struc­ture the data dif­fer­ently. The Tier 1 por­tal will be pub­licly avail­able by the end of this year. We ex­pect to launch the Tier 2 por­tal in the first half of 2015.

MH: Have in­sur­ers agreed to keep giv­ing you fresh data?

New­man: Yes. For Tier 2 you need cur­rent data and net­work de­sign. You need to know as con­tracts change who is in-net­work, and that’s been a prob­lem, both in the ex­changes and else­where. And you need real-time feeds with re­spect to the de­ductible.

MH: Is there a way this can make data in­di­vid­u­al­ized and mean­ing­ful for con­sumers?

New­man: You want to give peo­ple the range of prices and a sense of what cre­ates that vari­ance in price. That cer­tainly will help. You can get con­sumers who are en­gaged around fig­ur­ing that out, and you can also get burnout among con­sumers who say it’s too com­plex. We’re work­ing to make the con­sumer ex­pe­ri­ence as en­gag­ing as pos­si­ble.

You can look at an in­di­vid­ual’s be­hav­ior and say, “Oh, they ig­nored the price/qual­ity in­for­ma­tion.” But what hap­pened is they went to their doc­tor to dis­cuss knee surgery and the doc­tor said, “I just had the same knee surgery and Sara down the hall is a great ortho­pe­dic sur­geon.” What should a pa­tient do at that point? Just be­cause they didn’t do what we think they should do doesn’t mean they didn’t thought­fully con­sider the facts and ev­i­dence be­fore them. If peo­ple make de­ci­sions on things other than price, or in ad­di­tion to price, but we pro­vided in­for­ma­tion that’s use­ful for them, that’s great.

MH: Are there any spe­cific pro­ce­dures where you think th­ese data would be es­pe­cially help­ful?

New­man: It has to be those things that are dis­cre­tionary and schedu­la­ble, such as hip and knee re­place­ment. Emer­gency room vis­its— some­times yes, some­times no. Trans­parency is not the sil­ver bul­let. It’s one of many things that we need to do to im­prove the sys­tem.

MH: What does the fu­ture hold for your or­ga­ni­za­tion?

New­man: Both of th­ese web­sites are go­ing to have ini­tial re­leases and more ex­ten­sive builds over time. The other key thing is bring­ing in more hold­ers of claims data to make our abil­ity to re­port at a gran­u­lar ge­o­graphic level more pos­si­ble. We’re will­ing to work with the states, we’re will­ing to work with other in­sur­ers. Providers, hos­pi­tal as­so­ci­a­tions, con­sumer stake­hold­ers and em­ploy­ers are all wel­come to par­tic­i­pate in the ini­tia­tive. Our ul­ti­mate goal is to in­clude data from Med­i­caid and other pub­lic pay­ers. Adding data from the Fed­eral Em­ploy­ees Health Ben­e­fits Pro­gram would be par­tic­u­larly use­ful.

How do we pay for all this? At the mo­ment, it is the in­sur­ers pay­ing. I think that looks OK in terms of sus­tain­abil­ity. But other peo­ple need to step up with data, with en­dorse­ments and with com­mit­ments.

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