Commentary: What patients need to make affordable choices

By Nancy A. Giunto

For The Herald

Imagine you just moved to Everett for a new job with your spouse and child, who both have chronic medical conditions. Fortunately, you also have health insurance through your new employer.

But at the top of your to-do list is finding a primary care provider who will meet the very different health care needs of your family members. You want the best quality care for an affordable price, and you need to choose from providers who are in your health plan’s network. But where and how do you start looking? Is there one place where you can find trusted information in an easily understandable format that lets you compare potential providers?

The challenge for patients in our state and in our country is that the answer to that question is, for the most part, an emphatic and resounding “no.” Trusted, objective information on all aspects of health value — cost, quality and patient experience — is difficult to find.

The Washington Health Alliance — a non-profit powered by 185 member organizations representing those across the state who get, give, and pay for health care — is one of a handful of organizations collaborating with stakeholders to provide reliable, understandable data that can drive action. For a number of years now, we have been reporting on health care quality and value and ways to reduce overuse and waste, and providing this information to the public through our Community Checkup website and other reports that compare measures on cost, quality and patient experience.

Much of the data for our work on public reporting comes from a voluntary All Payer Claims Database that is supported by 35 data submitters. This is one source of trusted health care value data that consumers can access to help make informed choices.

Recently, I testified before the U.S. Senate’s Health Education Labor and Pension (HELP) committee on the topic of how transparency in cost and quality measures by health care providers and organizations can lower the costs of health care spending and empower patients. This was one of five hearings on the topic of reducing health care costs convened by the HELP committee, led by chairman Sen. Lamar Alexander, R-Tennessee, and ranking member Sen. Patty Murray, D-Washington. And, although we are pleased that Congress is now paying attention to the health care affordability crisis in our country and the role transparency plays in it, the truth is that finding data on health care value and understanding what the data means and how to act on it is extremely challenging for consumers in this country.

In other words, data transparency is important, but it is not enough.

Ideally, health care transparency must include all aspects of value — cost, quality and patient experience — not just cost alone. We must be able to look at cost and understand what we get for it. Do the services I am paying for improve the outcome of care? Are the services clinically appropriate or am I paying for unnecessary tests and procedures that don’t add value?

As I told the members of the Senate committee, we at the Alliance have learned that data alone does not change behavior. Transforming data into action requires multi-stakeholder engagement and mutual accountability. It takes trust, dialogue and tenacity. We need to make the data understandable, useable and actionable to consumers, providers, hospitals and clinics.

At the same time, providers and clinicians need to promote transparency to their patients. In a recent Alliance survey, patients were asked if the provider or office staff helped them find out the cost of care before getting the recommended test, procedure or medication. Only 23 precent of respondents answered yes to this question.

Health care transparency, done right, can lead to lower costs and better medical results. Value cannot be measured by a simple five-star rating system like the ones used on Amazon and Yelp. Empowering patients to choose high-value care and make better decisions about their health care is going to require more than just publishing prices online, as CMS has recently mandated for hospitals. It will require major changes in our approach to providing timely, accurate and meaningful information on all aspects of value.

If we expect consumers to navigate the health care system and make informed choices, we must provide objective, easy-to-understand information that is available on demand. It will take all stakeholders working together to make a complicated system user-friendly enough that health care consumers can easily find the information they need to choose the best, most affordable health care to meet their needs and individual preferences.

Transparency is a good and essential place to start. But if we want consumers to be in the driver’s seat on the road to affordable care, we need to provide them with a valid, user-friendly map.

Nancy A. Giunto is executive director of the Washington Health Alliance, based in Seattle.