Friday, July 20, 2007

New York AG Objects to Insurer's Method for Ranking Doctors by Cost and Quality--Just What We Need in Health Metrics--Lawyers

At the core of any market-based ability to control costs--pay-for-performance or consumer-driven care--is the notion that patients and payers have information available to them on a health care provider's cost and quality results.

Too often the health plan rhetoric--or marketing brochures--have got out ahead of anyone's real ability to measure cost and quality both accurately and in a way that is useful.

These efforts have also been plagued by providers too often more interested in undermining these efforts to protect their interests than cooperating in solving the complex challenges that crafting an effective system entails.

And it is not just the private markets that depend on progress here. Medicare has entered the world of pay-for-performance as well and it is likely that any government-run system would have to be use these kinds of metrics.

The latest evidence that we have a long way to go can be found, of all places, in the New York attorney general's office. From a New York Times article: "In a sharply worded letter, the New York State attorney general's office asked a health insurance company yesterday to halt its planned introduction of a method for ranking doctors by quality of care and cost of service, warning of legal action if it did not comply."

The letter was sent to UnitedHealthcare--but it could have been sent to any number of health plans looking to use provider performance information as a means to rank those in their networks.

But here's where this whole episode gets to the core of whether provider performance will ever matter. The AG said in the letter: "To compound the situation, we understand that employers may act on these 'ratings' to offer financial inducements such as lower co-payments or deductibles to promote 'cost-effective' doctors to their employees."

Well what else would they use it for?

Health care providers have complained that the United program just measures cost and not quality. Of course they would.

United has said cost and quality is "exactly what this is about." Of course they would.

When the day is done, it is in both the provider community's and the health plan community's interest to come to an agreement on how to measure both cost and quality.

While no one is riding any "white horses" in this business, I have to tell you that the provider community would have a disproportionate impact on developing a useful system if they could come to the conclusion that health metrics are here to stay and critical to our getting our health care system under control and take a leading role in their development--no matter if it is a private market system or a government-run system.

Good faith cooperation on both sides is crucial to getting a health metrics system that works for patient, payers, and providers.

We sure don't need an attorney general getting into the health care economics business--it's hard enough anyway.

Brian Klepper has also done a post on this issue. Brian makes a point I am not qualified to make arguing that the United tool suffers from a basic component needed for provider/payer relations to exist in good faith--transparency. He also makes a good argument for the importance of objectivity.

I suggest going over to, "The Doctor Weighs In" for a very good post and another perspective.


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