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Open data is essential to fixing health care

The American health care industry is full of opportunities for improvement. Despite decades of attention from business leaders and policymakers, we continue to spend too much on health care and accept outcomes that are far from optimal. I believe the lack of data sharing among providers and payers is a key reason why we are not seeing more improvement in this space.

As any manager knows, data is essential to improving a process or system. Without the facts, it is impossible to understand something, much less improve it. Yet in health care, a field that touches everyone on a personal level and comprises nearly a fifth of the economy, doctors, patients, and payers are all but flying blind. It’s no wonder that we aren’t doing better.

Although patients’ personal health care data is rightly protected by law for privacy reasons, data on costs and outcomes is secreted away in silos for business reasons. Even if clinical data is shared within a health system, it is often not analyzed due to a lack of resources or for competitive reasons. Providers also closely guard cost data to avoid losing leverage in negotiations with payers, and payers are reluctant to release their own cost data so they don’t tip their hand to their competition.

Despite these concerns, data on costs and effectiveness must be shared to align physicians towards a value-based culture and eliminate low-value procedures. According to a recent study published in the Physician Leadership Journal, 91 percent of specialists reported that increasing access to cost data would improve care, and only 40 percent said their organization was doing so. The topics of cost and finance also deserve more attention in medical school, so that new physicians learn how to better incorporate considerations of cost and value in their clinical decision making.

Payers, especially the nation’s largest health insurers, should also recommit to sharing cost data. The Health Care Cost Institute (HCCI) was founded in 2011 as a non-partisan nonprofit organization dedicated to using robust analytics to get the best answers to economic issues impacting the U.S. healthcare system. The HCCI publishes reports for use by policymakers and academics based on de-identified claims data received from four of the five largest health insurers (UnitedHealthcare, Aetna, Humana, and Kaiser Permanente). It also operates the website to help the public make better health care decisions by providing average prices for services at the national, state and local levels.

Unfortunately, the HCCI will not be able to release an update for 2018 because UnitedHealthcare stopped sharing data last year. Humana also announced that this will be the last year it shares data with the group. Although the HCCI hopes to announce new payer partners this year, the loss of data from UnitedHealthcare and Humana deals a serious blow to its mission to drive quality and value improvements in our health care system.

If transparency doesn’t come from within the health care system, it may soon come from without. The need for greater transparency in health care is one of the few issues that Congressional Republicans and Democrats appear able to agree upon. Republican Chuck Grassley and Democrat Elijah Cummings both attacked the lack of transparency in drug pricing during hearings in January. Similarly, Republican Bill Cassidy and Democrat Maggie Hassan are both exploring legislation to end the practice of surprise billing at hospital emergency departments. Even the conservative Foundation on Government Accountability is pushing “Right to Shop” legislation at the state level to require insurers to provide members with cost estimates for in-network services.

Providers and payers should embrace the opportunity to use open data to understand and improve our health care system on their own terms before government bureaucrats force it upon them.

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Jim Mueller - Mueller QAAS
Jim is the founder, President, and CEO of Mueller QAAS, LLC, an independent healthcare consulting firm located in Waukesha, Wisconsin. Jim provides leadership and strategic direction to Mueller QAAS, and also provides his clients with objective market insight on their employee benefit decisions.

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