Which way transparency Nirvana?

Mar 24, 2011, 6:52 AM, Posted by Michael Painter

First the good news—many are pushing the envelope on public reporting of health care information these days. For instance, this week the HHS/Health 2.0 Developer Challenge awarded honors to a new mobile app—using Hospital Compare data in new and innovative ways—try it. This application maps and provides some quality information as well as immediate ER waiting times for nearby hospitals. The idea of this app challenge, as you know, is to unleash moribund federal information, such as that sitting in the creaky Hospital Compare—to innovative types who will take it and create new—and, ideally, useful ways to present the information.  That’s an exciting turn that makes altogether too much sense.

Then Wednesday, I had the good fortune to attend a very thoughtful AHRQ sponsored meeting on public reporting of care information for consumers.  The meeting included a good mix of consumers, employers, regional alliance leaders, health professionals, researchers and others.  Bill Roper provided a motivating keynote. The messages ranged from overt optimism about the important role of public reporting in the drive toward sustainable high value care—to the sober assessment that although public reporting has matured (some)—we may also be reaching limits.  As Steve Jencks commented—we’ve made progress—but let’s keep some perspective here—public reporting still needs some quick wins—it “isn’t quite covered in glory, just yet.”

Meredith Rosenthal, in her plenary presentation, observed that public reporting is essentially about to graduate from high school—sitting in the guidance counselor’s office trying to decide whether to go to college or trade school.  Bob Galvin, in the closing session, added—that while public reporting is indeed in the guidance counselor’s office—and it clearly has a bright future—it’s a pretty confused student.

The problem? There seems to be near unanimous sentiment—at least in this group—that public reporting of quality and cost information is critically important to drive sustainable health care quality and value. Still, after 25 years of trying it remains a hard slog. One line of thought is: stay the course!  We just need to keep trudging.  The holy land is right over the next hill—measures need a few more tweaks.  All we need now are those outcome measures that the real people actually want.  We definitely need a lot more engaged consumer activists and patients to help create those useful measures.  Everyone needs help getting to the right presentation of that information—presentation that will tip the scale, make the difference—and then accelerate our long, twilight march toward high value care.

Or maybe not.

What if, instead, we already have a large chunk of the public actively engaging with health care information, such that it is—on HealthGrades, WebMD, Consumer Reports, Aligning Forces for Quality sites, Hospital Compare?  Bob Galvin in his comments estimated, say, 10 to 15 million people already.  What if we’re not actually going to get many more?  What if we’re not going to see an enormous marginal return in new numbers as we struggle to improve publicly reported measurement incrementally?  What if more and more of the public are not going to wake up one day and jump online to sort through ever more complicated information to make decisions?  Certainly, our currently motivated “mavens” need better, more usable information. But these mavens also may be the actual, ultimate consumer audience—when it’s all said and done.

There is another point—perhaps we should accept that sometimes people simply act on price—just price. Price can, in fact, be a very strong information signal—and extremely user-friendly—especially when people are first dollar sensitive.  Certainly, that’s not always the case—many people will avoid the cheapest care at all costs—because, for instance, they may be terrified of getting “cheap bad” care.  But still—no arguing about it—in the right circumstances price can move markets.

In his closing comments on Wednesday, Galvin provocatively suggested some nuance here.  Perhaps we should recognize that those important mavens out there will be mavens—and then work hard to get them the best measures and tools they need to make good recommendations and decisions.  And maybe we should also accept that for some things—some procedures, images, prescriptions—individual people will be, well, deal searching consumers—and will shop avidly, as we want them to do, for the best bargain—in those limited instances.  If that’s the case, let’s help them.  In addition to developing better, publicly reported quality and cost information for mavens, we should accelerate work significantly to identify those price sensitive activities for everybody else and rapidly develop (no easy task) that price information.  But really—and not to be too flippant—why not slap some useable, accurate prices on those items pronto—and let the bargain hunting begin?

This commentary originally appeared on the RWJF Pioneering Ideas blog.