Health Care Transparency for Employers
Transparency isn’t just our first core driver of High-Value Health Care, it’s at the heart of who we are and what we do. The Alliance® understands that in order to influence change in health care, we need a goal to strive towards and a benchmark to measure against.
As our CEO, Cheryl DeMars likes to put it, “You can’t manage what you can’t measure,” which is why the disclosure of cost and quality information is central to the mission of The Alliance. These measurements have come a long way, but gaps remain between the information we need and what is available today. In an ideal world, health care buyers would have a single online marketplace to compare meaningful cost and quality information from provider-to-provider and hospital-to-hospital.
Although health care does not quite work that way, The Alliance strives towards providing accurate, easy-to-access information that employer groups can use to compare and contrast both cost and quality. This allows consumers to make more informed decisions about their health while saving money. Transparency is also about measuring provider performance, so we can get to a health care payment model that emphasizes value of care instead of volume. But we can’t reward providers for value unless employers – the single largest health care purchasers in the country – become more active health care shoppers.
Ultimately, by joining a coalition and combining their purchasing power to disrupt how health care is purchased, employers can force policy changes that are more favorable for the consumer –
1. Public reporting of standard charges and negotiated rates for common, shoppable procedures. The rates negotiated between insurance companies and doctors and hospitals are considered proprietary information by the industry, but this keeps the public in the dark about price differences.
2. Using public purchasing programs to provide a benchmark to measure cost and quality. The power of public purchasing programs like Medicare and Medicaid can help align and improve public reporting of health care quality measures.
- Increasing access to data. Greater access to data will help researchers, entrepreneurs, and providers identify ways to improve care while lowering costs.
- Addressing surprise medical bills. By providing protection for patients who face out-of-network charges in emergency situations.
Transparency In Action
Employers of The Alliance are using QualityPath as a catalyst for these changes. Through QualityPath, we provide reliable information to both employers and providers on specific areas of care, such as in-patient surgeries like knee and hip replacements, and outpatient testing like CT scans and MRIs. Employers are then able to use that information in their plan design and encourage enrollees to choose providers that deliver great results at a lower price
We also offer bundled payments as an option for outpatient surgeries and tests – many of which come with warranties for additional peace of mind, when quality information isn’t available.
In health care, cost and quality are not correlated, so information related to cost and quality can be misleading. In fact, using our employer-specific Smarter HealthSM analysis, we’ve seen that high-cost providers do not necessarily deliver the best results, nor do low-cost providers deliver poor care. The Smarter Health analysis utilizes our quality assessment tool, QualityCounts, which provides managing and consulting services related to The Alliance’s core business of cooperative healthcare purchasing. Because when it comes to comparing the appropriateness of care across providers, it’s quality data that counts.
Health Policy Advocacy
We are evaluating quality information from both publicly available and commercial sources and investing in new, meaningful quality indicators to add to our comparative price information used by employers. Our health policy advocacy at both the state and federal levels aims to advance and accelerate these efforts. Want to know more about how The Alliance is getting involved in health care reform? Visit our Health Policy page.
Customizable Data Reporting: Smarter HealthSM
Employers want to provide their workforces with better health care options that cost less, without sacrificing the quality of care. That’s why in addition to cost data analysis, we include QualityCounts into our data reporting. These quality metrics ensure employers can find and provide access to high-value health care options for their employees.
Partners in Transparency
We’re proud to partner with like-minded organizations that put Transparency at the forefront of their mission, and participate in studies that use Transparency as a tool to drive lasting change. Here’s a few ways we’re connecting with these organizations:
Featured Insights on Transparency
A lot has happened since the White House issued an executive order in June of 2019, which led to the Hospital Price Transparency Act. In November 2020, the Departments of Labor (DoL), Health and Human Services (HHS), and the Treasury released the Transparency in...
We hosted employers for an action-packed hour to talk about how you can guide your employees to avoid costly balance billing. If you missed the webinar, you can view the recording or read on for a detailed recap of this important topic. Out-of-network claims...
The debate between fully insured vs. self insured health plans for employers is becoming clear. As enrollment numbers for traditional commercial plans steadily decline, self insured (or self-funded) plans continue to grow. What once was only for multinational...