The move to improve transparency in
health care has had an impact on both
consumers and providers. From the consumers’ perspective, transparency can
provide the price and quality information
they need to make informed choices
among health care providers, says William
McCarthy, director of large market sales
with UPMC Health Plan.
For providers, transparency represents
their ability to access the information they
need to get a comprehensive view of their
patients’ condition so they can offer a well-informed treatment plan. The challenge for
both consumers and providers seeking
transparency is the lack of detailed, standardized reporting, says McCarthy.
Smart Business spoke with McCarthy
about transparency and consumerism and
their effects on health care.
How can transparency be used to drive down
health care costs?
Consumers can use information on price,
quality and effectiveness to improve the
value they receive for their health care dollars. This requires consumers to have
access to resources designed to help them
make those complex decisions.
Technology that allows providers to have
a more comprehensive view of a patient’s
condition can improve efficiency by eliminating duplication of services and prescriptions and reducing administrative costs.
Transparency in the form of standardized
provider reporting improves quality.
Studies have consistently proven that higher quality health care translates into lower
costs. Health plans are currently using
quality measurements that can help to
identify providers that are employing best
practices and using this information to
improve quality among all providers.
How can cost information help consumers of
health insurance?
Cost information, quality and outcomes
information and alternatives can be very
effective tools in helping consumers make
health care related decisions.
Pharmacy leads the way in terms of
transparency. Most health plans have a
wealth of information available to consumers in terms of cost, effectiveness and
alternatives so that they can make informed decisions regarding which types or brands of drugs they should consider. This
information has been around long enough
that conversations between doctors and
their patients about it are commonplace.
Fewer resources are available to consumers when it comes to comparing doctors and hospitals. The information available today is fragmented, and there has
been no industrywide standard.
Health plans also offer provider comparison tools, like Health Advisor, that can help
consumers choose a hospital based on factors they find important, such as cost, outcomes, etc. However, consumers may find
these tools to be confusing or misleading.
Within the next few years, we will see the
standardization of provider information
that should make it easier to understand.
What should business owners know about a
health care plan before they purchase?
Business owners should ask the following questions before choosing a plan:
- How does your health plan report quality, and how do you measure up to your
competitors? - What types of decision-support tools
do you have to help my employees make
informed decisions about how to improve
their health and how best to spend their
health care dollars? - What strategies do you have available to improve the health and productivity of
my employees? - How will you engage my employees
and their families in programs to improve
their health? - Do you have examples of your success
in improving the health and productivity of
an employee population?
How do transparency and consumerism benefit business owners?
Business owners and executive leadership must lead the way in creating a culture
of health within their organizations. They
must support the introduction of tools and
programs designed to engage employees
and offer them the information and incentives that get them to change. If they are
successful, they can reap the rewards of a
healthier, more productive work force.
The term ‘consumerism’ as it relates to
health care benefits is often tied to high-deductible health plans (HDHPs); however, introducing consumerism does not necessarily mean introducing HDHPs. Consumerism can be introduced in the form of
cost information, decision-support tools
and health promotion strategies that
reward employees for improving their
health. This can be introduced with
HDHPs or more traditional plan designs.
How does it benefit employees?
Employees continue to share in the cost
of health care increases through employer
cost sharing, so they have a financial interest in getting the most value they can for
their health care dollar. Employees also
continually seek out strategies to improve
their health, and offering the resources
they need helps employees take steps to
improve their quality of life and their satisfaction with their health care program.
How does it benefit health care providers?
Providers are looking for ways to deliver
their care more effectively and efficiently.
Improving transparency through standardizing and streamlining reporting, storage
and access to medical records will help
them be proactive in their treatment.
WILLIAM MCCARTHY is director of large market sales with
UPMC Health Plan. Reach him at [email protected] or
(412) 454-5102.
