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Payers Play Crucial Role in Healthcare Quality Transparency

Healthcare groups stressed the importance of payer participation in new efforts to expand quality transparency to improve patient safety and lower costs.

Healthcare groups stress importance of clinical transparency for payers.

Source: Thinkstock

By Thomas Beaton

- Payers will need to take the lead in being transparent about healthcare quality and costs in order to improve patient safety and reduce unnecessary spending, experts told the Senate HELP Committee.

Payers can take a more proactive role in addressing patient safety and improving healthcare utilization, agreed four policy and provider groups.

Expanding public availability of patient safety scores

Leah Binder, President and CEO of the Leapfrog Group, an independent nonprofit representing payer and employer organizations, stressed that shortcomings in healthcare transparency lead to significant patient safety risks and higher care costs.

Leapfrog shared CMS data on central line infections to display how lackluster transparency increases patient risks and care costs.

“Measures that have not been reported publicly or less prominently reported show less improvement,” Binder said. “Extensive peer-reviewed literature suggests that the cost of complications and errors is highly significant; one study saw as much as $39,000 per infection for private purchasers. We conclude that driving improvement through transparency generates significant cost-efficiency as well as better care.”

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Payer and employer groups can address transparency by collecting data about provider organizations, and then sharing that information with other stakeholders.

Leapfrog’s hospital patient safety report includes 27 measures across 2600 hospitals, and is available to the public.

Binder added that employer-led efforts to create transparency can help ensure providers are accountable for patient safety and costs.

Binder suggested that organizations such as the CDC, along with other federal agencies, should make hospital safety data publicly available so beneficiaries can evaluate the quality of provider organizations. She also believes that members of Congress should explore new ways to compare provider performance and improve transparency.

“Other techniques for comparing performance could be built or expanded, such as patient surveys to assess clinical outcomes and complications, automatic tabulation of performance through electronic medical records, and public release of traditionally hidden records of performance, such as accreditation reports,” Binder explained.

Assessing individual provider performance to promote transparency

READ MORE: Payers See Cost, Quality Gains with Value-Based Payment Models

Bill Kampine, Co-Founder and Senior Vice President of Analytics at Healthcare Bluebook, said that individual provider performance data is needed to improve clinical transparency

Kampine believes that there are noticeable differences between a provider’s individual quality data and an organization’s quality data. The differences in data may not accurately reflect if patients are recieving the best possible care.

“Selecting a high-quality hospital does not guarantee a high-quality physician,” he said. “Patients must be able to independently evaluate both facility and physician quality.”

Kampine suggested that payers and employers need to consider hiring a third-party organization to help payers promote clinical transparency.

Hiring intermediary groups and quality data experts can help payers strategize on ways to expand price transparency for beneficiaries.

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These groups help payers to create systems that make it easy for members to navigate cost-effective healthcare and learn about health plan benefit design. Third-party transparency experts also help members understand healthcare prices and teach employers how to provide cash incentives for members that use high-quality care.

Kampine suggested that Congress should explore new ways to share CMS data and historical claims data to improve transparency about provider quality.

Employer groups need access to retrospectives claims to identify patterns and trends in healthcare quality. Kampine added that publicly available CMS data on hospital outpatient departments (HOPD) and ambulatory service centers (ASCs) should be expanded.

“However, broad access to detailed encounter level data for physician office and outpatient surgeries, in both the HOPD and ASC settings, is deficient,” Kampine said. “Greater access to detailed data that allows comparison of quality outcomes for outpatient services, specifically the HOPD and ASC settings, would improve transparency of provider cost and quality for consumers.”

Adopting value-based payment models that focus on provider quality

Nancy A. Giunto, Executive Director of the Washington Health Alliance, said that health plans can take an active role in promoting data exchange, and increasing clinical quality transparency, when designing value-based payment models.

“Transparency of information is dependent on the commitment of health plan leaders to engage and trust others with their data,” Giunto explained. “These leaders understand that transparency is paramount to building trust with purchasers and to aligning efforts to transform health care for the patients we all serve.”

Giunto advised Congress to expand CMS’s efforts in accelerating value-based payment adoption as a means to promote clinical transparency.

She said CMS may see greater returns on value-based payment if new policies added transparency tools to help consumers understand their best healthcare options.

Giunto added that private payers would also benefit from policies that promote clinical transparency for CMS programs, since private payers could draw on the tactics used by CMS.

Combining healthcare quality data with cost data

Ty Tippets, CEO and Administrator at St. George Surgical Center, said that payers should build upon efforts to make healthcare more transparent by posting price information alongside quality information.

Tippets explained that payers should help consumers make informed choices about healthcare utilization by sharing quality and cost information simultaneously. Payers that publish healthcare prices with quality data may help beneficiaries choose the best possible healthcare provider for specific needs.

“Price is only one factor in determining value,” Tippets said. “Lower prices must be combined with high-quality care and a safe patient environment. In addition, patients must be disabused of the notion that higher costs indicate higher quality. As health policy experts will tell you, there is no correlation between cost and quality in terms of health care outcomes.”

Tippets believes that federal entities should release the prices of services for public payers. He added that greater price transparency of public payer programs can inform all healthcare stakeholders about the relationship between healthcare costs and quality.

The strategies suggested in the HELP Committee hearing encourage payers to not only evaluate costs, but to also consider quality, when trying to boost meaningful healthcare transparency.

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