Federal government initiatives don’t usually jump to mind in the category of
innovative thinking. But even if Washington is following the private sector, its
sheer heft makes a difference when it jumps onto an issue.
This might be the case for President Bush’s executive order instructing four
government agencies, including the Center for Medicare and Medicaid Services, to
provide health care price and quality information to beneficiaries. The
instruction also compels them to improve health information technology systems
and make them work together to produce more transparency into quality of care
and pricing.
In addition to Medicare and Medicaid recipients, the plan participants
covered by the order are those in the Departments of Defense and Veterans
Affairs and the Office of Personnel Management. Together, they represent about
25 percent of the health insurance market. Some of the information also will be
available to the public.
With the president demanding more price and quality data, businesses may
follow suit in their contracts with health providers.
"These things are already happening without a government mandate, but they
will be further encouraged with the executive order," says Katie Mahoney,
manager of health care policy at the U.S. Chamber of Commerce.
One of the major health care providers, Aetna, is already offering price and
quality information to its plan participants in select markets. The company is
confident that other providers will do the same.
"This will be embedded. This will be a way of doing business," says Robin
Downey, head of product development at Aetna.
The business community embraced Bush’s move because it gives momentum to
consumer-driven health care. Proponents of consumer-driven health say the
success of such plans hinges on the ability of individuals to save money by
making decisions based on price and quality.
"You might see more companies willing to make this the (only) type of health
plan they offer rather than just a choice," says Ted Nussbaum, head of group and
health care consulting with Watson Wyatt North America.
The key to price transparency is to get providers to divulge the dollars and
cents they paid, which they often see as a competitive advantage. "The challenge
for the private sector will be to have price disclosed as opposed to cost,"
Nussbaum says.
On the quality side, there likely will have to be much give-and-take among
interest groups as they grapple with definitions of quality care.
Two organizations—the Ambulatory Care Quality Alliance (AQA) and the Hospital
Quality Alliance—have brought businesses and health providers together to work
on benchmarks.
"Having the government say, ‘We’re going to do this (price and quality
transparency)’ makes it all the more urgent for hospitals and doctors to work
with HQA and AQA to come up with consensus measurements," says Steven Wojcik,
vice president of public policy for the National Business Group on Health.
Seattle might be one community that takes the lead in the transparency
process because of interest from major employers in the area, says Maria Ghazal,
director of public policy at the Business Roundtable, an association of CEOs of
large corporations.
The enthusiasm is shared by corporations throughout the country. "Our CEOs
have been pushing for a year now for greater transparency in the health care
system," Ghazal says.
—Mark Schoeff Jr.