Health Care Transparency For Employers
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.
“You can’t manage what you can’t measure”
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 – like the below:
- 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.
- 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 HealthSM 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 Public 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
In our continuance of real dedication to Transparency, The Alliance and its employers participated in RAND Corporation’s Hospital Pricing Transparency Project (Rand 3.0) – a nationwide analysis of commercial inpatient and outpatient hospital prices paid by private insurers and employers vs. Medicare prices. The study provides a much-needed measuring stick that employers can use to leverage better rates and better quality with hospital systems.
Paul Meyer, COO of The Alliance, and Kyle Monroe, VP of Network Strategy & Value Measurement, both serve on the Wisconsin Statewide Health Information Network (WISHIN) Board of Directors. WISHIN is an independent not-for-profit organization dedicated to bringing the benefits of widespread, secure, interoperable health information technology to patients and caregivers by building a statewide health information network to connect physicians, clinics, hospitals, pharmacies, and clinical laboratories.
The Alliance is a proud to partner of the Wisconsin Collaborative for Healthcare Quality (WHCQ), who publicly reports and brings meaning to performance measurement information that improves the quality and affordability of health care in Wisconsin. WCHQ’s members represent more than 65% of Wisconsin’s primary care physicians.
The Alliance is a proud member of The National Alliance of Healthcare Purchaser Coalitions, a nonprofit, purchaser-led organization dedicated to driving health and healthcare value across the country.