How Transparency Can Transform Health Care

One of the fundamental ideas behind value-based health care is that patient outcomes—good and bad—have to be understood, shared, and compared. Such transparency makes it possible to spot patterns that can unlock best practices or, alternatively, halt practices that have negligible or even harmful results.

Outcomes won’t tell you anything useful, though, unless they’re measured and reported in a uniform way. In March, 2016, ICHOM, the International Consortium for Health Outcomes Measurement, announced that it will launch the first-ever Global Health Outcomes Benchmarking (GLOBE) program. The program will begin gathering health care outcomes data from providers around the world, allowing clinicians to compare their patients’ outcomes to those of their peers. (ICHOM is a not-for-profit organization BCG co-founded together with Professor Michael Porter of Harvard Business School and the Karolinska Institute.)

This move toward transparency represents a historic turning point for health care—but execution is critical. Transparency can be an extraordinarily powerful tool, when used correctly. But focusing on the wrong metrics can set off a series of unintended consequences. As ICHOM’s new program gets off the ground, it’s important to take stock of what makes transparency effective—and what can undermine its value.

Four Essential Factors for Transparency Success

First, let’s look at what makes transparency effective. When it works, transparency delivers insight, clarity, and a clear path to improved outcomes. The most effective transparency initiatives will succeed in four areas:

• Disseminate information relevant to important decisions: The information sheds light on a complex decision-making process (around health and safety, for example).
• Offer a clear and actionable message: The data is presented in ways that people can understand and act on.
• Drive change: The data encourages positive changes in behavior and decision-making for both the disclosers and the public.
• Create real value: The data collected and shared encourages the “right” behaviors and serve the purposes for which they were intended.

So how do these four factors fuel a successful initiative? The automotive industry provides a superb example of the way transparency can achieve meaningful results.

A Success Story for Car Safety

In 2000, SUVs were found to have a serious safety problem: they tended to roll over. In an effort to help consumers better evaluate car safety, the U.S. government created a five-star safety rating for all vehicles. This initiative was a huge success, in large part because it adhered closely to the four criteria listed above.

First, the government shed light on a complex topic by testing vehicles and rating them on a five-point scale. The five-star rating was simple, easy to understand, and the score card was displayed at the point of purchase: on cars or in show rooms (offering a clear and actionable message). Consumers were given an incentive to purchase safer cars—and car manufacturers had an incentive to improve their safety rating (driving change and creating real value).

The results of this program speak for themselves. A recent study showed that the chances of a driver dying in a crash in a late-model car has fallen by more than one-third over the last three years, due in large part to improved vehicle designs and safety technology. By selecting the right data and sharing the right metrics, the five-star safety ratings program has undoubtedly saved thousands of lives—while simultaneously encouraging the auto industry to improve the safety of its vehicles.

The Prize of Getting Transparency Right

When transparency is done right, it can seem obvious why it works. But this is an advantage conferred from hindsight. Getting it right is hard and leaders need persistence and strategic foresight to achieve optimal results. There will be resistance from people who fear their shortcomings will be exposed or who worry that the data will be distorted and misused. Others will feel threatened by transparency and the ways it may undermine their entrenched business interests. It’s also just very difficult to change human behavior, so the data must be delivered at the right time and in the right way.

Finally, even the best intentions can go awry. Poorly designed transparency initiatives can lead to unintended consequences. For example, patients may benefit from being given access to mortality rates as an aid to help choose the most competent surgeon, but transparency into outcomes could backfire if it motivates surgeons to avoid high-risk cases that might damage their scores. It’s crucial to anticipate and guard against the potential for perverse outcomes.

In short, while ICHOM has enjoyed incredible success and is generating extraordinary momentum, the hardest part of the change is likely still ahead. 

But it will be worth every ounce of effort. Transparency has the power to bring about massive change on a global scale. Think of Linus Torvalds, whose transparency movement in computing inspired the largest installed base operating system in the world: Linux. This free, publicly accessible, and fully transparent operating system now powers the lion’s share of the Internet.

ICHOM, too, has the power to spark change at a global level. Indeed, we very much expect it to do so. It will require government leaders to rally all stakeholders—patients, payers, providers, pharma, and medtech—around the goal of transforming health care systems through transparency.

If we achieve this, I have no doubt we will improve the lives of many millions of people around the world.