Boston Globe reporter Jeff Krasner does a great job covering business issues for the Globe and was kind enough to attend the seventh — and most recent — public meeting of the Coalition for Affordable Health Care. The Coalition is a group of Massachusetts businesses and health plans (including Harvard Pilgrim) who’ve joined together to promote state policies that reduce the increase in health care costs and improve quality.

The Coalition is focused on several issues:
1) Leveraging the Commonwealth’s Health Care Quality and Cost Council (of which I’m a member) to collect and make public understandable information on health care cost and quality — by provider and by procedure — in Massachusetts. The group believes that to do something about health care cost and quality, the public must have reliable information about why costs are high and how quality can be improved, and that we should go a step further by having the Council conduct annual hearings on what’s driving health care costs.
2) Ensuring that there are no new mandated benefits. Massachusetts has 43 mandated health benefit laws, among the most of any state in the country. Any proposal to expand the state’s generous collection of mandated plan benefits needs to be costed out by the MA Division of Health Care Finance & Policy to determine if the costs outweigh the benefits of adding a new one.
3) No new assessments, charges, taxes or fees should be levied onto Massachusetts employers or health plans until something is done first about the rising cost of health care.

Somehow, when we talk about more transparency — and better information about health care costs and quality — people presume that means we’re promoting more Consumer Driven Health Care. Consumer Driven Health Care is based on the idea that if individuals have more skin in the game — higher deductibles and higher out of pocket spending for their own health care — they’ll shop harder and smarter for health care services. In fact, Jeff quoted me saying exactly that in the paper the next day.

The funny thing is, I actually said just the opposite. I said I thought the jury was still out on consumer driven health care. I added that creating financial incentives for people to choose lower cost generic medications had worked very well — increasing generic use from 40 percent of all prescriptions up to almost 70 percent of all prescriptions. I also said that applying that logic to the rest of health care was a bit of a stretch.

For me, more information — heck, ANY information — on provider performance in the public domain is the first step toward an informed discussion about health care cost and quality. No one — at any level — including the folks in the provider community — can truly engage on these issues in the absence of any publicly available information on how people and organizations are doing, relative to their peers.

Jeff also quoted me as saying that the notion that more health care is automatically better health care is an urban myth. Right on. In fact, there’s a fair amount of research — mostly from the folks at Dartmouth — that more care can, in some cases, make things worse for patients.

Enough. Let’s get the data into the public domain and engage the debate. That’s the place to start. If consumers use it to get better, cheaper care — terrific. But that’s hardly the only — or even the best — reason for publishing the data in the first place. Okay?

Posted by Charlie Baker in Health Care Costs, Health Care Quality, Transparency