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Melina Kambitsi, Ph. D.
Senior VP, Business Development
& Strategic Marketing
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Mike Roche
Director of Business Development
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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.

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“You can’t manage what you can’t measure”

– Cheryl DeMars, CEO | The Alliance

Although health care does not quite work that way, organizations like The Alliance strive 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 – 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

QualityPath®

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.

QualityCounts®

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 Health^SM 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^SM 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 Health^SM

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:

In our continuance of real dedication to Transparency, The Alliance and its employers participated in RAND Corporation’s Hospital Pricing Study in 2020 – a nationwide analysis of employer-purchased health care. The study will provide a much-needed measuring stick that employers can use to leverage better rates with providers.

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.

Cheryl DeMars, CEO of The Alliance, is a Board Member for the Wisconsin Health Information Organization (WHIO). WHIO is a nonprofit organization that aims to improve the quality, affordability, safety, and efficiency of health care in Wisconsin. They drive this goal with their All-Payer Claims Database (APCD) – the single largest source of health care data and information in Wisconsin.

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 Quality Forum, a non-profit organization that measures and standardizes critically important initiatives to enhance health care value, make patient care safer, and achieve better outcomes.

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.