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While the discussion goes on about the issues of cost and quality, one thing that no one can debate is that to improve, those delivering care need good data. Whether we choose to view it as a deficiency of the current system or an opportunity, the fact is that those delivering care do not now have access to enough information to get us from where we are to where we need to be.
The health plans currently control most data that exists in an electronic format (No one believes that using paper-based data can be useful over the long run.). But there is no agreement among the plans regarding making this available to providers in a uniform format. At this time, plans release information in differing formats (sometimes paper based), covering different spans of time and different subjects. From this, providers of care are expected to try to provide a uniform standard of care to all of their patients and improve what they do.
This has not worked and it is not hard to see why.
Add to this the fact that patients change plans at a rate of about one in five per year and that there is no uniform patient identifier at this time to capture their information as they move across plans (and change providers of care), and the task becomes even more difficult. Finally, when we look at claims-based data that comes from the plans we note that an error rate of about 30 per cent exists in the claims data for coding diagnoses — unless the providers are given access to culling through the information and correcting it.
Care will be improved when doctors have access to data that allows them to quickly identify which of their patients have a particular problem, what further care they need, and how they are doing. Costs cannot begin to be addressed until those who are ordering the care know what the costs are! Value cannot be improved until we are able to clearly connect cost and quality in a manner that is easily understood by those who deliver care.
Today, the Quality and Cost Council is faced with an opportunity. In setting standards for data submission from the plans it can go beyond the basic mandate of producing information for the public on quality and cost. It can actually become an instrument of improvement by providing a professional portal that could allow physicians and other care providers to use this information for care provision and improvement. Reports will achieve more if they are the byproduct of improvement, not an end in themselves.
Dr. Magee is President of the Massachusetts Medical Society.
This program aired on December 12, 2007. The audio for this program is not available.
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