"Score One for Transparency in Health Care" by JudyAnn Bigby, M.D.

Massachusetts health care consumers just got a whole lot savvier. As part of its commitment to improving health care quality and containing costs, the Commonwealth launched today an interactive websiteto help residents select high-quality, lower cost care and to encourage providers to improve quality and contain costs.

These efforts are particularly critical as Governor Patrick, his Administration, and our partners in the Legislature continue to move forward with health care reform implementation. Since 2006, more than 442,000 people have enrolled in insurance programs, making Massachusetts first in the nation in the percentage of uninsured. Care for the remaining uninsured, financed by the Health Safety Net, has decreased by more than 36% as enrollment has increased.

These are critical achievements, but the architects of Massachusetts’ historic 2006 health care reform initiative wisely recognized that controlling costs and improving quality are key components to ensuring the long-term sustainability of health care reform. The Health Care Quality and Cost Council has developed a consumer-friendly website that allows a diverse range of stakeholders to compare common health care procedures at different hospitals and outpatient facilities. A patient considering knee replacement surgery, angioplasty or a mammogram can now visit the new site to see how cost and quality measures might differ between various local hospitals for that procedure.

The website represents a significant achievement in ongoing, multipronged efforts to control rising health care costs and ensure that residents of Massachusetts can get the best care available, which is particularly important as we continue to expand access.

This resource could not come at a better time. Massachusetts spends more per person than the national average in every category of health care, with hospital care, nursing facilities, and other health care services, including dental care, home health, and durable medical equipment accounting for the most significant part of the difference.

The vast majority of individuals do not know the true cost of medical services. They have even less access to information about the comparative value of that care, for example, whether a single procedure is provided at the same quality and cost at various hospitals.

The true cost of care is tightly guarded by insurers and hospitals alike. Although there are many reasons why this information is not generally made public, most can be boiled down to the common concern that the loss of confidential pricing information will disrupt one of the most competitive health care markets in the world.

Many analysts argue that this lack of consumer information contributes to the overall rise of health care costs. Without access to comparative information, individuals cannot possibly make informed decisions about the kind of care they receive, where to get it, and how much it costs.

The initial data posted on the website reveal that there are differences in cost and quality of care across the state. Higher costs for Boston teaching hospitals were expected; some community hospitals have higher than expected costs. Higher quality does not uniformly track to academic centers, but they provide high quality care overall. The Council attempted to post quality data related to every procedure for which costs are available. Unfortunately, there is less information available than should be to compare quality of care for even common procedures and diagnoses.

More research is needed to understand how access to price and quality information impacts decision-making and how it affects outcomes, access, and costs. Whether the website empowers consumers to spend health care dollars more efficiently, only time will tell. Even if the information does not change consumer behavior, transparency will motivate providers to improve quality and hopefully decrease their costs. Payers and others need to make payment and pricing decisions based on quality of care, but this information should not be used to increase cost-sharing for consumers.

Providers should spend more time on improving quality, not simply reporting quality. Through the HealthyMass initiative, the Patrick Administration is developing a process to align performance measures so that providers can report one set of uniform measures. This will enable the state and others to measure the impact of quality improvement initiatives. We must also make it simpler for hospitals and other providers to report real time quality measures to the Council efficiently so that the public is better served.

The state’s new website is not a magic bullet, but it is another key step in Massachusetts’ historic health care reform initiative. It is a beginning toward getting the right information to all stakeholders—the public, providers, insurers, employers, and government alike.

JudyAnn Bigby, M.D.
Secretary for Health and Human Services (MA)