Toward Increasing Consumer Access to Health Care Information on by rrboy


									   Consumer Access to Health Care Pricing and Quality Information:
       A Consumer-focused Portal for health care information
                           Draft 11-30-06

Growing Need for Health Care Information: Virginia’s health care system has many
strengths; from state-of-the art hospitals and treatment centers to highly trained and
dedicated health care providers. Virginians also point with pride to many public and
private efforts to improve access to health care and make it more affordable to those most
in need.

Virginia businesses and consumers face rising health care costs and differences in the
quality of care provided. An ever-growing number of Virginians are paying more for
health care through increased co-payments, deductibles, and premiums. Consumers want
and need information to help them make more informed health care purchasing decisions.

A Consumer Health Care Portal: The Commonwealth of Virginia and health care
stakeholders already sponsor and support a “home” for a variety of consumer health care
information. Virginia Health Information (VHI), a nonprofit organization collects and
publishes information on Ambulatory surgical centers, HMOs, hospitals, long term care
providers and physicians. VHI’s website hosts more than a quarter million visitors
annually. Given this existing platform for health information, stakeholders have
presented their desire for a VHI-administered consumer health information portal to
VHI’s Board of Directors .

Stakeholders also recognize the growing availability of information on health care quality
and pricing from health insurance companies, government sponsored programs, and
private sources. There is every reason to increase consumer awareness of and use of
information from other sources. Unfortunately, since this information is spread around
cyberspace, finding and using this information can be difficult and time consuming.

What Virginia lacks is a portal or clearinghouse to simplify access to consumer health
care information from many locations. Such an approach is attractive as it:

      Creates a one-stop-shop for access to information
      Avoids duplication of efforts by leveraging existing information
      Can gather and display information most relevant to a consumer’s needs
      Would provide information on pricing and quality to persons without health
      Would provide easy access to Medicare, state sponsored information and
       commercial health insurance information for those covered by those programs

Sources and Types of Information: Health insurance companies are expanding
information available to those enrolled in their health insurance plans. Expected out of
pocket costs to the consumer and quality information are available from a number of
health insurance companies with more under development.

Anthem provides members with information on a number of procedures

Physician-specific information on pricing is available for Aetna members

Other health insurance companies offer varying types of information on costs, and quality
of care.

Government Programs

The Center for Medicare and Medicaid Services makes information available on
ambulatory surgical centers, diagnostic centers, home health care, hospitals, and nursing
homes. Hospital information includes whether certain processes of care such as aspirin
use after heart attacks, telling smokers to quit,

The Virginia Board of Medicine publishes information on licensed physicians including
education, years in practice, specialties, malpractice information,

The Leapfrog Group is a voluntary program aimed at mobilizing employer purchasing
power to alert America’s health industry that big leaps in health care safety, quality and
customer value will be recognized and rewarded. Among other initiatives, Leapfrog
works with its employer members to encourage transparency and easy access to health
care information as well as rewards for hospitals that have a proven record of high quality

The Virginia Hospital and Healthcare Association is publishing information for
consumers on the most common reasons for hospitalization, mix of payers and hospital
financial assistance information.

Outpatient Surgical Information will be available from VHI in 2007 for 7 procedure
groups. Information on the cost, charges, and number of procedure performed in
ambulatory surgical centers, hospitals and physician’s offices will be available.

Virginia Health Information has Quality information on all types of cardiac care
Other information on HMO quality, nursing facilities, and physicians is also online

Commonly Performed Diagnostic Procedures: Consumers in high deductible health
plans are more likely to incur first dollar costs for procedures such as MRIs, CT scans,
xrays and similar evaluations. The uninsured would also benefit from this type of
information. The potential exists for acquiring upper and lower ranges of the typical
billed vs. allowed charges from information service companies. Initial dialogues have
begun regarding availability of this information for public reporting.

Next Steps: While not exhaustive, a potential timeline for next steps related to a
collaborative Virginia transparency portal is outlined below. The pace and scale of
information and resources made available through the portal is dependent on input from
the stakeholders and the Health Care Reform Commission.

January – June 2007
 Consumer Research
          o Assemble existing research on how consumers use health information on
             pricing and quality, and most effective ways to present health information
             to consumers.

   Incorporate data on outpatient services
           o VHI ambulatory surgery data
           o Public payor sources
           o Consolidated private payor claims data (e.g., Subimo)
           o Licensure/accreditation dimensions of quality

   Launch Phase 1 of Portal
          o Initial outpatient data (VHI data etc.)
          o Links to health plan, hospital sites
          o Ties to other consumer resources
                  Senior Navigator
                  VHI Long term care, cardiology, OB reports, etc.
                  Others

June – December 2007
 Consumer Research
          o Evaluate site use
          o Conduct focus group on potential enhancements

   Broaden outpatient data
          o Additional quality information
          o Additional services and provider detail

   Develop information on bundled costs for common services/procedures
          o Hospital, physician, diagnostic and drug costs for common conditions
          o Research related decision support tools

January - June 2008
 Launch Phase 2 of Portal
          o Enhanced inpatient and outpatient price data
          o Additional quality information
          o Initial bundled cost estimators and related decision support tools


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