Can openness transform health care?
In a thoughtful new report, the Committee for Economic Development (CED) suggests that by being open, the U.S. health system could be transformed.
The concept of "openness," as described by CED in Harnessing Openness to Transform American Health Care, goes beyond what we traditionally thin
k of as transparency. Of course, transparency is critical for helping markets freely flow. But CED uses openness as an M.O. for transforming markets. Think: open source computing, where information or intellectual property is generated at some origin, and then others build on that initial idea (that's the open-source Linux mascot, Tux the Penguin, pictured on the right). Thus, openness spawns innovation, which is CED's mission to promote.
"If information can be modified, repurposed, and redistributed freely it is more responsive, and therefore more 'open,'" CED explains. "The Council has found that an increased degree of openness often leads to greater innovation because it allows contributions to a work from more individuals whose differing insights and experiences can add considerable value," the report reasons.
However, CED recognizes that openness has its limits and constraints, such as with personally identifiable health information which must be kept secure and confidential, or with intellectual property such as patents for medical discoveries which merit protection for the life of the patent.
CED found that it takes between 13 to 17 years for 14% of research findings to get into the hands of practicing physicians. The Council argues that by introducing openness into the information chain in health care, evidence-based practices and innovative products can disseminate more quickly into the general medical community. This would result, ultimately, in improved individual patient outcomes and overall enhanced public health.
The report analyzes openness through various health segments, including biomedical research, clinical trials, electronic health records, privacy and security, consumer health information, public health, and medical devices.
The CED has been examining the role of openness in a variety of industries, and highlighted the benefits of openness in a previous report, "Open Standards, Open Source, and Open Innovation."
The concept of "openness," as described by CED in Harnessing Openness to Transform American Health Care, goes beyond what we traditionally thin
k of as transparency. Of course, transparency is critical for helping markets freely flow. But CED uses openness as an M.O. for transforming markets. Think: open source computing, where information or intellectual property is generated at some origin, and then others build on that initial idea (that's the open-source Linux mascot, Tux the Penguin, pictured on the right). Thus, openness spawns innovation, which is CED's mission to promote. "If information can be modified, repurposed, and redistributed freely it is more responsive, and therefore more 'open,'" CED explains. "The Council has found that an increased degree of openness often leads to greater innovation because it allows contributions to a work from more individuals whose differing insights and experiences can add considerable value," the report reasons.
However, CED recognizes that openness has its limits and constraints, such as with personally identifiable health information which must be kept secure and confidential, or with intellectual property such as patents for medical discoveries which merit protection for the life of the patent.
CED found that it takes between 13 to 17 years for 14% of research findings to get into the hands of practicing physicians. The Council argues that by introducing openness into the information chain in health care, evidence-based practices and innovative products can disseminate more quickly into the general medical community. This would result, ultimately, in improved individual patient outcomes and overall enhanced public health.
The report analyzes openness through various health segments, including biomedical research, clinical trials, electronic health records, privacy and security, consumer health information, public health, and medical devices.
The CED has been examining the role of openness in a variety of industries, and highlighted the benefits of openness in a previous report, "Open Standards, Open Source, and Open Innovation."
Health Populi's Hot Points: There are a couple of sticking points to the CED proposal on openness which are not trivial: in fact, the CED mentions them in a short section on "open business models." They are what CED terms the mental obstacles of (1) "not invented here" and (2) "not sold here." These two perspectives usually prevent folks in the for-profit world from being open-minded.
Beyond these two, I would hasten to add a third constraint on for-profit companies whose lifeblood is innovation: that is, the life and value of the patent. Not everyone has Linux DNA running through their blood.
Furthermore, the CED's proposal for openness would not, in and of itself, transform health care without a realignment of incentives across stakeholders: for example, consider providers, such as primary care vs. specialty care, or outpatient vs. inpatient vs. home care providers. Openness will go only so far when one provider's payments are at stake.
And it's costs, after all, that need transforming in the health system. Over the very long run -- decades, perhaps? -- evidence-based practices might proliferate throughout the U.S. health system which would, eventually, help to stem cost inflation. But without structural change within the system, costs would continue to rise. See Bob Laszewski's post at the Health Care Policy and Marketplace Review of October 16, 2007. In it, Bob -- a brilliant Washington insider who critically appraises health politics with the best of the best -- talks about CED's proposal for health reform published last year in "Quality, Affordable Care for All." While the CED is all about "openness," they remain closed to the idea of explicitly addressing health cost containment.
posted by Jane Sarasohn-Kahn at
5:32 AM
2 Comments:
I will rush right over to the CED report. It really echoes one of the most surprising findings to us from our Iowa and now Washington surveys.
In both states, the top thing that people wanted was "health care professionals should be required to give patients information about costs and benefits of treatment and services so people can make good decisions."
There was 87% agreement on that in Washington and 84% agreement in Iowa. And across party lines of Republican, Democrat and Independent as well---they ranged from a low of 82% (Independents in Iowa) to a high of 87% (Democrats in Washington). Republicans were at 85% and 84% in each state.
We did not expect this to strongest consensus point, but it was in both states.
Our Iowa findings are posted and we will be posting the Washington findings next week. We hope to have the final report comparing and analyzing the findings between Iowa and Washington next week as well.
Then, hee, hee, we are comparing the candidates' proposals with the values the people have in health care and we will post that information as well next week.
Keep up the good work.
Cheers and more later. Kathleen
By
Kathleen O'Connor, At
January 25, 2008 2:53 PM
Thank you for the reference to the CED Digital Connections Council's statement on "openness" and health-care innovation. However, please note that you have mischaracterized the ealier CED statement, "Quality, Affordable Health Care For All."
That CED statement explicitly argues that quality, universal coverage is not possible without reductions of cost. The statement explains that the best way to induce innovation and process improvement to control cost is by giving every American a cost-conscious choice among competing health plans -- like what federal government employees get through the Federal Employees Health Benefits Plan (FEHBP). (This is NOT the very different ideal of forcing patients to shop for individual services and providers when they are sick.) We would implement that concept by giving each household a credit equal to the cost of the low-priced quality plan in their region. (Quality would be enforced in the same way as it is now for the FEHBP. An insurer that tries to market a cheap, low-quality plan is refused the right to do so by the market organizer, the Office of Personnel Mangement. Under our proposal, a "Health Fed," modeled after the structure and independence of the Federal Reserve, would fulfill than function.) Any household that wished to purchase a more expensive plan would be welcome to do so. That household would simply have to pay the incremental cost of the plan, with after-tax dollars.
Under such a system, every health plan would have strong incentives to control costs and maintain quality, because consumers would choose among plans according to their own judgments of quality and cost. Amazingly, that is not the case today. More than three out of four employees covered by employer-based insurance have no choice of plan; they must take or leave the one plan offered by their employers. Only about six percent of all employees can both choose from among alternative plans AND save money if they choose a less-expensive plan. No wonder there is no cost-consciousness in the health-care market.
Some would argue that the only true cost control is, literally, price controls. We reject that assertion, and that policy. Price controls distort choices and breed manipulation and circumvention, as is the case in Medicare today. In contrast, a cost-conscious choice among plans by consumers would encourage both plans and providers to offer the care that consumers want at a price they can afford. There is no such incentive now, and providing such a reason to control costs would make all the difference.
By
Joseph J. Minarik, Research Director, CED, At
January 25, 2008 3:11 PM
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