Why We Need Quality/Safety Transparency in Healthcare
Thomas Campanella
President, Campanella Consulting, Inc. Professor Emeritus of Health Economics, Baldwin Wallace University
My last blog focused on?healthcare transparency ?from a price perspective.?As I noted in the?healthcare transparency blog,?it is important to provide a linkage between disclosed provider pricing and quality/safety scores by reputable third parties. Unlike the sectors outside of healthcare, many consumers perceive that if provider services are lower priced, it must mean that quality is also lower. Conversely, if prices are higher, then quality must all be higher. Most studies have shown that there is no correlation between higher prices and quality in healthcare. High prices are a function of leverage in negotiations in the healthcare sector between the provider (e.g., hospital) and the payer (e.g., commercial carrier); consequently, there should be a pairing of healthcare prices with user-friendly data about quality/safety.?
We are all aware of multiple organizations that attempt to grade and report on the quality of healthcare providers, such as the U.S. News and World Report, but all of them have flaws. For example, the U.S. News and World Report quality ratings for hospitals do not include safety ratings (such as hospital-caused infections) as provided by the Center for Medicare and Medicaid (CMS) as well as? The Leapfrog Group .
Factoring in CMS's safety ratings is especially critical since they focus on?preventable hospital-caused harms . Preventing avoidable errors, accidents and complications are one of the best ways to ensure a safe and efficient hospital stay. Incidents like medication errors or infections contracted at the hospital can pose a tremendous risk to a patient's health.
Finally, an ideal ranking system accurately informs patients about quality and safety, which will incentivize providers to improve both.
Cleveland Health Quality Choice
As a non-clinician, I do not claim to be an expert on quality measures in healthcare, but I do know the importance of quality/safety transparency. As I discussed in a prior blog,?My Healthcare Journey , early in my career, I was the Vice-President of Healthcare Finance and Care Management at Blue Cross & Blue Shield of Ohio/ Medical Mutual of Ohio in the 1980s/1990s. While in that position, I was first exposed to public reporting of quality measures because of an employer-led initiative called Cleveland Health Quality Choice.
As discussed in the?Center for Studying Health System Change.?Community Report: Cleveland, Ohio, 1997, ?"Cleveland Health Quality Choice?(CHQC) is a notable feature of the Cleveland health system. Established in 1988 as one of the first community-wide quality initiatives in the country, CHQC profiles participating hospitals along six dimensions and reports the results to the public semiannually. The program was originally sponsored by the business community and was subsequently adopted by the hospital and physician communities, partly in anticipation that businesses might selectively contract with providers based on their participation and ranking in CHQC."
The? Health Action Council of Northeast Ohio, a coalition of more than 140 businesses representing some 350,000 covered lives, helped found CHQC.?
During the mid-1990s, as in other urban communities throughout the country, there was major hospital consolidation. In December of 1998, the two biggest hospital systems decided they were no longer going to collaborate with CHQC, which effectively ended this ground-breaking quality initiative. The hospital systems cited the cost of the quality initiative as the main reason for ceasing their collaboration.?
CHQC reported on a broad spectrum of hospital outcomes, including patient satisfaction, in-hospital mortality, length of stay, hospital-acquired complications, and cesarean section rates for adult medical, surgical, obstetrical, and intensive care patients.
As a non-clinician and consumer of healthcare, I believe that acuity-adjusted in-hospital mortality and hospital-acquired complications, along with patient satisfaction, are the most critical indicators. I especially believe that acuity-adjusted hospital-acquired complications are a major indicator that not only provides the consumer/employer with an objective scorecard to compare with other providers but also provides them with an overall assessment of the provider's commitment to quality and safety relating to their patients. Another potential addition to this list would be a score relating to readmissions, but I also know there are complicating factors relating to this measure of quality.?
User-Friendly Quality/Safety Transparency
I recognize that health outcomes remain the ultimate validation of the effectiveness and quality of medical care being provided, but to my knowledge, we still struggle to effectively compare providers of care based on specific health outcomes in a user-friendly manner for reporting purposes.?
I also know that organizations tend to focus on processes vs. outcomes because they are easier to measure. My concern with processes is that it is like rewarding a salesperson for the number of calls they make to customers vs. rewarding actual sales.?
The publishing of healthcare quality measures, along with pricing information, will evolve over time. As demand for this information increases by payers (especially employers), it will also become more user-friendly as third-party technology vendors vie for increased market share. Technology companies will differentiate themselves by how they provide user-friendly actionable price, quality, and safety information to employers and consumers.
Knowing providers' pricing and quality information, self-insured employers can develop value-based benefit designs and create incentives to steer patients away from high-price, low-quality providers and navigate them to lower-price, high-quality alternatives.?
Prior to enacting any employee engagement initiative based on enhanced transparency, employers need to establish an ongoing communication process with their employees to allow them to better understand the importance of identifying value-based providers from their own personal perspectives as well as from the company. Ideally, the employer should initially focus on the quality/safety ratings of providers since this will send a strong message to employees about the employer's commitment to their health. If the quality/scores of providers are somewhat close, then price differences should play a significant role in healthcare purchasing decisions.?
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A key driver of escalating employer healthcare costs is high-end procedures. Establishing Centers of Excellence (COE) is an effective way to both addresses the high costs of these procedures and, more importantly, provide a quality outcome. Enhanced price and quality transparency will position self-insured employers to better identify the appropriate COE for their employees.
Also, enhanced utilization of patient navigators by employers and payers will help facilitate the transition to value-based providers of care.
As demand for healthcare price/quality/safety measures increases, healthcare payers, such as commercial insurance companies, will also be incentivized to produce user-friendly reporting to differentiate themselves from their competition.
Finally, and most importantly, an ideal ranking system accurately informs patients about quality and safety, which will, in turn, incentivize providers to improve both.
Conclusion
I am not an expert on cars or mutual funds, but I have learned over the years to rely on Consumer Reports and Morningstar as tools to guide me in making buying decisions. Will we ever find that "gold star" rating vehicle for healthcare services? Probably not, but we can do much better than where we are today.?
As noted previously, I am not claiming to be an expert in quality/safety reporting. I do know that we need to aggressively pursue enhanced price and quality transparency in healthcare that sets the stage for value-based competition in our communities.
I welcome feedback from experts and vendors who are knowledgeable in this quality/safety field to provide further insight to the readers of this publication.?
Finally, we recognize that it is important to have healthy communities, and to that end, much more can be done by focusing on the population's health needs outside the walls of the hospitals. Non-profit hospitals receive billions of dollars of tax waivers and, in return, they are required to provide a "Community Benefit." ?I believe it would be appropriate to include a ranking of non-profit hospitals, along with pricing/quality/safety scores, related to the "Community Benefit" they provide vs. the level of tax exemption they receive. If this ranking were made available to consumers and employers, it might influence their decisions as to the choices of hospitals they utilize and hopefully create a sufficient incentive for hospitals to focus on overall population health.
Tom Campanella is the Healthcare Executive in Residence at Baldwin Wallace University. Backed by more than 35 years of experience in the industry—particularly the health insurance, physician and hospital sectors—he’s focused on strategic advising and community outreach.?Follow Tom’s articles on LinkedIn for his latest weekly coverage of the healthcare industry.
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Product, Data, Technology, Business Operations Leader | Real World Data | Data Insights, Analytics, & Cybersecurity | Future of Product & Technology | AI & ML in Healthcare | Digital Transformation
2 年Enjoyed reading your blog, Thomas Campanella, thank you for sharing. My hope is that integrating the right technologies into our healthcare systems will allow for more transparency all around. Actionable insights are going to play a role. Driving transparency is definitely a goal that needs major work.
Chief Executive Officer (Retired) at Parma Community General Hospital (now University Hospital’s Parma Medical Center)
2 年Tom - I too appreciate your example of "measuring calls vs. sales", but I'm not sure that processes in healthcare are really easier to measure - perhaps just easier to question. An outcome, be it survival, or absence of complications, or price "is what it is" We've done better in the area of safety - with the help of Leapfrog and a few others. Transparency has been more accessible as well. So where does accountability for transparency of outcomes lie? I remember a then "breaking edge" program called Cleveland Health Quality Choice, back in the mid-nineties, which attempted to rest it with the providers; which proved interesting but was plagued with technological issues and lots of excuses and protests about the data (which was not particularly user friendly, and had a few reliability problems) from the participants. With the evolution of so many strong technological programs/companies, I believe progress can be made which will offer providers a clear framework to evaluate and report outcome data for all of our consumers - payors, employers, communities and citizens. ;
Medical Stop Loss | Captive Insurance | Health Value Advisor | Distinguished Toastmaster
2 年Always great insight Tom. If you don’t mind I’ll sprinkle in some thoughts from my professional lens… 1. Most commercial carriers design their apps and tools to protect their real customers, the providers that agree to be in-network. Once in a while I see a new marketing push for patient steerage, sponsored/partnered with these commercial carriers, however the advisors I work with quickly find out there is still a lack of data for external parties to review the “process” as you say. The outcome of bottom line cost for the employer is generally the only measure. Progress I guess. 2. The majority of American healthcare is either fully insured, level funded, or self-funded with a commercial carrier integrated model. It’s easy. As Bob M. once told me, “No one has ever been fired for recommending XXXX.”. However it’s logical arguments like yours that point to the lost value in the chain that bring hope. 3. Risk retention groups (RRGs) that take on medical malpractice risk for provider groups are building data sets. It would be fascinating if one partners with a MSL group captive to begin to pave the way in creating a MorningStar like report. Thx Tom.
Experienced healthcare analyst with a diverse skill set and a passion for wellness
2 年Processes vs. outcomes indeed! Great blog update, Tom!
Director, Financial Operations - Echo Health
2 年You make some great points Tom. It's amazing that with all of the technology out there, as healthcare consumers, we still struggle to find basic quality/price information in our healthcare system.