When it comes to health care, purchasers want answers to two simple questions: Which doctors and hospitals get good results? How much does it cost?
We ask these questions routinely before making any major purchase. But not in health care. It is a black hole in the American economy. It sucks in money but emits no light. So throughout most of America, these two basic questions are unanswerable.
I work with some of America’s largest health care purchasers, the 60 members of the Pacific Business Group on Health — companies such as Wells Fargo, Target and Boeing, as well as public agencies such as CalPERS. Together, they provide health care coverage to 10 million Americans and their dependents in all 50 states, spending more than $50 billion each year.
Despite this heft, when it comes to shopping for health care, we are all in the same boat. The only way they can typically differentiate hospitals, clinics or doctors is by reputation.
We must do better. Providers should be evaluated on measures that patients and employers care most about — improvements in quality of life, functioning and longevity. After a patient has a knee replacement, is her pain reduced? Can she walk normally? When a child has asthma, can he sleep through the night? Can he play sports?
Purchasers want to identify providers that consistently achieve good results and use resources efficiently so they can reward them financially and encourage patients to seek care from them. This requires reliable data. But when I recently asked our members how they would describe national efforts to measure the quality of health care, they responded with one word: “abysmal.” Without useful public information on quality, they are forced to develop their own quality measures, a piecemeal approach that is taking both purchasers and providers down the wrong path.
Federal action can put us on the right path by doing three things: developing useful measures, building out the national data infrastructure, and making use of performance information for payment and public reporting.
First, we need measures that are useful for creating a successful marketplace. Of the nearly 700 measures endorsed by the National Quality Forum, the majority measure clinical processes — did the patient getting a knee replacement receive timely antibiotics? — or structure — did the surgeon use a computerized medical record? These are useful for improving clinical quality, but consumers and purchasers care most about outcomes: Did the patient walk pain free a year later?
Only the public sector can ensure this information is available. Congress should direct the Centers for Medicare and Medicaid Services to identify and adopt useful, standardized measures that address consumer and purchaser concerns.
If we move quickly to develop measures that can identify high-performing providers, employers and other purchasers could change payment policies, reconfigure their health care networks and create consumer incentives to encourage the use of high performers. This is the critical market signal needed to drive improved quality and affordability.
Second, we lack the national data infrastructure to support continuous quality improvement and the ability for people to make informed decisions about their care. We have made important progress in the adoption of electronic health records, but it is time to jump-start a new era that takes advantage of the explosion in mobile technology and the Internet.
The CMS and the Office of the National Coordinator for Health IT should develop and implement a framework that will allow for evaluation of a patient’s care over time, including the appropriateness of care decisions, outcomes and resources consumed. This data should also permit Congress and the public to assess whether new payment and delivery schemes — such as bundled payments and accountable care organizations, and even the new insurance marketplaces—are contributing to improved health. This will enable employers to evaluate the performance of physicians and health care organizations across settings and time.
Third, purchasers want Medicare, the largest purchaser, to quit paying providers in ways that reward volume over value and leave millions of beneficiaries without useful quality information.
Congress should require the secretary of Health and Human Services to embed the most useful quality measures into Physician Compare, Medicare’s program for measuring physician performance, as well as all federal recognition and payment programs within 24 months. This can be done as part of the “doc fix” to replace the Sustainable Growth Rate for updating Medicare’s physician payments — and it doesn’t have to wait until 2019.
A health care marketplace where providers compete based on their ability to improve care and manage resources is the best medicine. We can’t get there without a flow of information — who gets good results and how much does it cost — that consumers and purchasers can use to make critical health decisions.
David Lansky is president and CEO of the Pacific Business Group on Health.