Industry Trends: Managing Health Care Quality and Cost with Data and Transparency

Industry Trends: Managing Health Care Quality and Cost with Data and Transparency

How to fix our nation’s health care system is a topic that many have weighed in on, but no answers or consensus have been reached in terms of the necessary steps to ultimately improve cost and quality. The use of data and transparency by benefit consultants and employers is clearly needed to push cost control and improve outcomes.

President Trump released an Executive Order requiring hospitals to disclose their prices, but the reality of that happening quickly and effectively is unlikely due to the fact that hospitals have approximately 30 to 100 different prices for the exact same medical procedure. Regardless of government intervention, the push should continue from private industry—benefit consultants and ultimately employer groups—to demand information to improve quality and drive meaningful change. Using industry lingo, this is referred to as “data mining”, and it can have a substantial impact on improving quality and decreasing costs.  But in order to use and leverage the data, you have to be able to get the data. Based on a client’s size and a carrier’s policy, it will dictate the data and detail you are able to receive.

Insurance carriers can be restrictive with data, and it is a reflection of where the industry currently stands and what they are willing to release. But there are other health-analytics-driven technology firms that can help support the mission of providing more meaningful insight and measurement of data to improve outcomes and reduce costs.

In addition to making costs transparent to drive appropriate decision making, lowering the cost of health care is contingent on controlling the frequency and severity of claims. By this, I am not referring to cutting or reducing care, but compliance to disease protocols and maintaining appropriate care plans for chronic conditions (i.e. diabetes) or maintaining a healthy lifestyle. The frequency and location of procedures is also an important metric to assess data. Referring patients to specialists and facilities with better outcome rates and volume inherently reduces the cost of care and drives better results and patient experience.

Ultimately, health care data and transparency will drive, first and foremost, quality care, which will ultimately lower the cost of care through these efficiencies. Waiting for government regulation is not the answer, but we as consultants and employers must continue working to drive change and improvement in the health care system.