A Health Plan Work in Progress: Hospital-Physician Price and Quality Transparency, a report from those indefatigable folks at the Center for Studying Health System Change (CSHSC), explains that health plans are ramping up transparency efforts in what is still an early phase of market development and adoption.
CSHSC looked at two aspects of transparency: price and quality. For larger plans, who are more advanced in their price publishing projects, these efforts are seen as crucial for competitive positioning, according to CSHSC; for smaller plans, they’re defensive in nature. Regardless, very few plans are providing price data that’s customized for enrollees.
One broker in CSHSC’s study commented, “Price information is sparsely available, and where it is available, it’s of relatively low utility for the average member.” That’s the bottom line of the study.
The area of quality appears to be more mature, according to CSHSC. Still, the drag on proliferating quality data is that providers can push back on a provider’s ‘poor quality’ determination. Perhaps that’s why there’s more hospital quality profiling being done than physician quality data being pushed out to enrollees. CSHSC found that most plans tend to rely on nationally reported quality data from third parties (e.g., Medicare, HealthGrades, or Subimo). It can be a pass-the-buck strategy for the health plan, who might say, “this isn’t our rating, this is Medicare’s.”
CSHSC smartly points out that there are risks in being transparent. Consumers could misinterpret the data; for example, believing that a higher price equates to higher quality. Other consumers might not know how to evaluate or use the data in decision making. Finally, there is liability risk in that unhappy providers might push back in the form of lawsuits (as was the case recently with the Washington State Medical Society suing Regence BlueShield).
Health Populi’s Hot Points: Low utility, indeed. Can you spell “r-e-l-e-v-a-n-t?” Why should consumers tune in to price information if it’s not directly useful to them? Averages are only relevant to those who pay those prices.
One plan that has lots of physician data is Medicare, the granddaddy of all health plans. However, Medicare doesn’t release physician-specific data to the public.
While transparency is seen by a broad range of health stakeholders as playing a major role in empowering health consumerism, we’re not ‘there’ yet. Not even close.