The Key to Overcoming the Challenges of Transparency in Healthcare

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Transparency in HealthcareThroughout the healthcare industry, we hear a call for greater transparency. But what exactly does that mean?

The truth is that transparency in healthcare means different things to different people. We’ll look at some different segments in the healthcare industry working to adapt to the call for transparency.

Transparency from a Consumer Perspective

It’s no surprise that access to information about the price and quality healthcare services can help consumers make better decisions about their care. What is surprising (to anyone not familiar with our industry) is how difficult it has been in the past for consumers to get this information. The truth is that patients rarely know the real cost of care until after they’ve received it. And the price—and quality—of a particular service can vary considerably by provider. What’s more: higher price does not necessarily equate to higher quality.

Today, consumers faced with high-deductible health plans and increasing out-of-pocket expenses demand quality and cost information. They seek answers to questions such as:

  • What will my true out-of-pocket costs be?
  • Where can I get the best care for my money?
  • What if I can’t pay?
  • If my doctor ordered this test or drug, does my insurance cover it? If not, why not?

The industry is starting to develop best practices around consumer transparency. For example, many payers are making it easier for their members to determine costs. United Healthcare and other payers even have a cost estimator application available online to its members. In addition, some health systems are publishing quality information on their websites. Advocate Health in Chicago produces an annual value report revealing its performance on a number of quality metrics. Texas Children’s Hospital has made a similar commitment. They publish information online about their quality performance. Texas Children’s Hospital shows how they compare to other children’s hospitals in the United States and how they compare over time. They state on their webpage that transparency will help improve care.

Transparency from a Physician Perspective

In a purely fee-for-service system, a physician bears no financial responsibility for the quality of care delivered by his or her referrals partners. The shift to accountable care is changing that. Physicians in accountable care contracts are now accountable not only for the care they provide but for the quality delivered by referral partners. These physicians now want to know which potential referral partner has demonstrated the best outcomes. That’s why transparency around care quality is becoming increasingly important to physicians participating in value-based contracts.

Transparency Between Payers And Providers

The shift from a fee-for-service reimbursement system to value-based care is driving unprecedented collaboration between payers and providers. Let’s face it, though: transparency is a challenge between these two parties. In the past, they have guarded their proprietary information jealously to maintain their competitive positions in price negotiations. Transparency represents a major cultural change. This change is happening but slowly.

Payers and providers are starting to cross the divide of the bargaining table. They are focusing on a form of collaboration where everyone starts on the same footing because they can access the same data. Though they have a lot of work to do to overcome some cultural barriers to data sharing, they are making progress. One of the most important things they can do to get started is to agree on what quality, efficiency, and patient satisfaction metrics they will jointly prioritize and track.

No payer/provider collaboration has yet to demonstrate dramatic results—but they are showing results. One example is the teamwork between Cigna and Granite Health. They recently reported the first-year results of their collaboration (another example of transparency). Both their quality and cost scores were better than the overall New Hampshire average for the same time period. Some of their successes include:

  • Medical costs trend 1.2 percent lower
  • ED use down 4 percent
  • Advanced imaging down 7 percent

Transparency Within a Healthcare Organization

Transparency within a healthcare organization is essential in any effort to improve quality and cost. For example, it is difficult to expect a hospital’s operating room workforce to reduce the cost of an operating room when they don’t know how much individual operating room resources cost.

In fact, a common complaint inside a hospital is that people simply don’t know how much different resources cost. In a recent article in Becker’s Hospital Review, Cleveland Clinic CEO Dr. Toby Cosgrove revealed that they have begun to tape price lists to supply cabinets in some of their ORs. That is certainly one method for helping clinicians increase awareness of what resources they use and how much they cost.

Many hospitals face a lack of transparency about more than costs. They also have to deal with a lack of transparency about outcomes, what quality initiatives other departments are taking on, what lessons other departments have learned from their quality-improvement efforts, and so on. Increasing this kind of dialogue and transparency is a priority for forward-thinking organizations. But these efforts can run into both technical and cultural barriers.

Culture has a big impact on transparency. In some organizations, quality metrics have historically been very guarded. Changing this attitude can involve wading through political waters. Often, a significant barrier to transparency within an organization is simply bandwidth. Typically, only certain people—like someone in the IT department that administers a particular database—have access to the information you need. You have to wait in line to get information from them. Once they are able to get back to you, you may have follow-up questions … and you have to get in line again and wait until they have time to address your questions.

The good news is that these challenges can be overcome with the right technology and team processes. We’ve seen examples among our own clients of organizations leveraging data warehousing technology and innovative team structures to improve operational transparency. Texas Children’s Hospital’s Department of Pediatric Radiology is one example. This group of 30 radiologists performs more than 220,000 procedures annually, making them one of the largest dedicated pediatric radiology centers in the country. Using enterprise data warehouse (EDW) and advanced analytics, administration, radiologists, and staff are now able to see information like:

  • Average procedure duration
  • Results turnaround time to providers
  • Anesthesia utilization
  • Patient flow cycle time (including check-in to exam, check-in to results, end of exam to results, exam begin to exam end, and percent of appointments cancelled)
  • Utilization of each piece of equipment — a process that has shown them where they have additional capacity so they can move volume around the system to maximize utilization and reduce scheduling lags

This solution helps everyone in the radiology department see what everyone else is doing and how their own performance contributes to the end-to-end process. When everyone understands the dynamics of how the process works and the quality that can result from a smooth, standardized process, the organization can become more efficient, reduce variation, improve quality, reduce costs, and improve patient and staff satisfaction.

Driving Greater Transparency in Healthcare

Whether you’re a payer or a provider, success in our evolving industry ultimately comes down to demonstrating higher quality at a lower cost. That’s what everyone really wants. The trend toward transparency means that traditional walls dividing organizations are coming down. When the dust settles, you must be in a position to demonstrate that you have the highest quality and lowest costs.

When you think about it that way, the transparency aspect of the shift to greater value in care is almost the easy part. Finding ways to let people know how you’re doing in terms of cost and quality is a relatively simple matter compared to actually improving cost and quality. Improving cost and quality requires finding the best way to derive actionable insights from all the data your organization has collected. It means pulling together data from disparate sources and getting that data into the hands of frontline staff whose day-to-day activities impact quality and cost. It means making cultural and organizational changes to get everyone involved and on board with changing the way care is delivered. It means prioritizing improvement efforts and measuring progress. Doing this successfully requires a commitment to transparency, but, more than that, it requires the right advanced analytics solutions.

Learn about the best system for process improvement for payers and providers or the three best practices for payer-provider collaboration.

What is your organization doing to improve transparency? What challenges have you faced in this process? More importantly, what are you doing to improve quality and cost?

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