HCI3 Update from the Field: Culture Bred by Opacity

Submitted by francois.debrantes@hci3.org on Friday, July 26, 2013 - 08:58

Newtown, CT – July 26, 2013

A culture bred by opacity inevitably leads to denial of responsibility, and this week’s physician survey in JAMA should be the last nail in that coffin – if you haven’t yet read it, then read Zeke Emanuel's editorial on the survey. While it’s depressing, it shouldn’t come as a surprise that barely 30% of physicians feel we should move away from fee-for-service, or see themselves as responsible for escalating costs of care. The usual suspects are brought out as the culprits – unfair lawsuits, non-compliant patients, greedy vendors – and while they share in the responsibility (as we all do), the real culprits are those who continue to stand in the way of full and complete market transparency. Why am I so certain of this? For five years we’ve been implementing payment innovation in the field with health plans and providers. And in every one of these implementations the “aha” moment has been the revelation to the physicians of the total cost of an episode. For a surgeon, knee replacements cost health plans roughly $2,500. From a PCP’s viewpoint, a year’s worth of good care for a diabetic costs $1,000. And when they find out the real numbers are $25,000 and $5,000 respectively, they’re shocked….and they should be. Suddenly the implications of what they do – to which facility they send patients, the type of implant they use, the post-acute care setting the patient ends up in, the frequency of potentially avoidable complications – become clear, and actionable. Denial turns into self-realization.

What this means to you – it’s not just consumers who need information on the price of episodes of care or individual services, physicians need the information as well. States and health plans have an obligation to provide these data in a clear, unambiguous and timely fashion. In a related article this week, a representative of the CT Dept of Public Health says that the state's F grade on transparency seems undeserved because consumers have access to some pricing information on one of the state’s websites and through the Freedom of Information Act. Seriously? He should take a walk in East Hartford and see how many folks there would know how to file a FOIA. The hubris and idiocy of such a statement would be shocking if it weren’t so indicative of this culture of opacity. The sequelae of such a culture are myriad. From the denial of physician responsibility to the ever escalating prices of health care services and the production of medical devices with little or no health benefits. It’s time to put an end to it and this week we’ve taken the first steps towards that. In a webinar sponsored by NASHP we released model legislation that states can use to finally shed light on the price of health care (thank you Laura Loeb). And we’re going to continue to put pressure until every state has enabling legislation to change this market forever. In collaboration with CPR and others, we’ll keep releasing our state scorecard on price transparency. We’re going to publicly show, wherever we can, the variability in prices that exist in a market. We’re going to activate consumers to vote with their feet. And we’re going to help physicians understand how to better manage the costs of a complete episode. And we won’t stop until this job is done.


Francois de Brantes
Executive Director
Health Care Incentives Improvement Institute, Inc.
w: www.hci3.org