When Serigraph went to a consumer-driven health plan four years ago, we realized we had to give our co-workers the tools to be better buyers of care.
We decided to make health care prices transparent, and we asked our co-workers what they thought about that. Their answer was: Great, but we want information on quality as well.
We were able to crack through on all-in hospital prices on 17 common procedures. And now we give cash rewards under a "MedSave" program to co-workers who pick a high-value provider in the lower two quartiles for net price. For instance, they get $2,000 if they pick the best hospital for a new hip.
But we were able to offer only meager information on quality, such as the volume of procedures at a particular hospital. And we offer no information on price or quality for doctors or clinics.
Meanwhile, the push to provide price transparency has gained a head of steam. Health plans and some providers in the state are putting out various levels of information on prices. The Wisconsin Hospital Association offers its CheckPoint program. UnitedHealthcare has a Web site on prices for its members. So does Humana. Anthem is promising one for Wisconsin in 2008.
It's a mixed bag in terms of accuracy, since most lay out average discounts instead of exact discounts - a major deficiency, because discounts vary widely.
Doctors and clinics still escape scrutiny for the most part.
To fix that, legislators from both sides of the aisle have stepped up. Sen. Jim Sullivan (D-Wauwatosa) and Rep. Steve Wieckert (R-Appleton) have introduced a bill that requires providers to quote "usual and customary charges."
Other legislators are ginning up variations on the transparency legislation, some requiring more precision about net prices (after discounts) or on episodes of care (all charges included top to bottom).
These legislators have listened to the growing army of consumers. It could get done before this legislative session ends.
What, though, is to be done about nearly non-existent quality information?
Various organizations in the industry, including Medicare, are starting to provide some benchmarks. But it is coming at a glacial pace.
We need a quicker fix, and there is a method that could work in the near term. It is simply quality audits.
For decades, all vendors in manufacturing have faced in-depth audits from customers. It submits to the audit or loses the business.
The results are known immediately at the end of the audit. And they have major immediate consequences on improving quality.
Major health customers, like the coalition of large employers in Milwaukee or the Wisconsin Department of Employee Trust Funds, which buys health care for public employees across the state, could do the audits of hospitals, clinics and doctors and then make public the results.
Some companies, like Racine's S.C. Johnson & Son Inc., already select centers of excellence for certain health care procedures. They survey medical facilities with their own doctors to make the selection.
Shouldn't the rest of us know the quality of providers, too?
Industry experts will say medicine is too complicated to be audited and rated. Baloney. Just send in medical experts, doctors in specialties teamed with black belts in quality to do the audit, and the findings will be valid.
Actually, providers already are audited by professional organizations. But the results are seldom made public. Why not? Is it protection from criticism or use of the data in malpractice lawsuits?
Indemnification for providers may be necessary through legislation. But if that can't be done, the public still needs to know about outcomes at different medical facilities. Audits by customers are an answer.
If health care is to be bought on value, like other goods and services, quality reporting has to catch up with the spreading price transparency.
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