HFMA VIEWS

Scott MacStravic

The vast majority of discussions on transparency for HCOs relate to some combination of quality and cost information that should be shared with consumers and businesses so they can make the most informed choices regarding health care. While the evidence is still out as to the extent to which such information will make a significant difference to either set of customers, the idea seems a logical accompaniment to calls for healthcare reform that aim to increase the extent to which consumers take responsibility for their healthcare choices.

But any such reform that is limited to only decisions on sickness care treatments and providers after consumers are faced with acute or chronic disease crises is nowhere near even half the answer. Ultimately, and most reformers agree with this, consumers are going to have to act more responsibly with respect to their health, not just their reactive sickness care needs. Ideally, this means they will choose those behaviors and lifestyles that will reduce the overall incidence and prevalence of disease in the population, not merely facilitate better decisions about where and from whom to get sickness care.

It would be an interesting element of transparency if sickness care organizations such as hospitals and physician practices engaged in sharing with their patients not merely how much their sickness care will cost, and what outcomes they can expect from it, but how the patient could have avoided the need for such care in the first place, and can avoid a repetition of the same event or episode. Arguably, reaching patients with information when they are facing the threat of expensive and often risky sickness care is a great “teaching moment” opportunity to call their attention to proactive health management (PHM) alternatives that might work to prevent future events, or help their family and friends avoid similar problems.

Such “event-timed” contacts could contain information on the hospital’s or physician’s own PHM services, where they offer some, or referrals to other sources, where they do not. Ideally, these communications would be as transparent about the costs and average outcomes of the specific PHM interventions or providers discussed, enabling consumers to make informed choices in these matters as well.

Such communications could point out the financial advantages to consumers or reducing the risk factors that were probably active in causing the reason for their existing need for sickness care. This would enable consumers to estimate how much they would gain, in “discretionary income” by not repeating the existing illness. Examples of what has been saved by other consumers who acted to prevent getting the same and other conditions in the first place could also serve well. This could include the lost time from work or school, lost income, and out-of-pocket costs associated with the condition or other preventable conditions, as well.

After all, it makes eminently good sense for hospitals, and at least for large physician groups, to engage in or purchase PHM services for their own employees. Given the higher productivity and performance available through healthier workforces, and the notoriously unhealthy nature of most workforces in the healthcare industry, this only makes good management sense. And whether they become suppliers or purchasers of PHM services, providers should become well informed about the outcomes and costs of available suppliers.

It would clearly be against their best financial interests, in the long run at least, for providers to promote and help steer consumers toward PHM services, since they reduce the need, demand, and expenditures for sickness care, and thereby most providers’ revenue. But the future revenue prospects for sickness care payment by third parties and even consumers is pretty dismal, and “joining ‘em” rather then “licking ‘em” may be a wise strategic move. And for providers with strong mission or professional commitments to the health of communities, promoting healthier citizens is far more beneficial in that arena than is curing them after they get sick.

In the long run, it is arguably in providers best financial interests as well, since delivering sickness care where it is rare enough to be affordable will be significantly better than doing so when no one wants to pay as much as it costs to deliver. The constant grinding down of payment levels compared to costs, and pressures to reduce costs even at the expense of quality, will inevitably make sickness care a far less rewarding business, both professionally and personally.

There is no reason why most sickness care providers could not compete with specialized PHM suppliers in the PHM market, particularly in disease management, and in the lucrative employee health management parts thereof. And it offers such providers a real opportunity to get not merely “on the side of the angels”, but on the same side, as part of the solution, with all the other stakeholders who are committed to reducing the overall healthcare costs in the country, rather than remaining part of the problem.