Does Public Reporting of Cost or Resource Use Measures for a Consumer Audience Make Sense?

1. Does Public Reporting of Cost or Resource Use Measures for a Consumer Audience Make Sense? AteevMehrotra, MD, MPH University of Pittsburgh School of Medicine RAND Health

2. Outline • Current landscape of measures • Concerns with current model • Suggestions for improvement

3. New Jersey Hospital Price Compare

4. Medicare Hospital Compare

5. Florida Agency for Health Care Administration. Nursing Home Guide

6. What is a Cost or Resource Use Measure? • Terminology can be confusing • Resource use, value, relative costs, efficiency • “Efficiency” per IOM is a quality domain • Distinction b’ween cost & efficiency/value • Costs for a given outcome • Health outcomes per dollar • Cost & Resource Use Measures • PMPM / patient per year • Per episode costs • Per hospitalization costs • Utilization measures – generic prescribing • Overuse measures • Price transparency – daily price of nursing home

7. Selection Model Selection of Providers Berwick et al, 2003, Medical Care

8. Concerns with Selection Pathway • Consumers typically immune to costs • Higher costs = higher quality • Lack of trust and understanding • Not relevant to decisions actually made Our view is that in their current form and absent any financial incentives, publicly reporting of cost measures is unlikely to lead to the hoped for consumer response.

9. Making Selection Pathway More Viable Improvements - Relevant choices - Less is more - Link to quality - Link out of pocket $$ - More information - Test, test, test

10. Making Selection Pathway More Viable Improvements - Relevant choices - Less is more - Link quality, not value - Link out of pocket $$ - More information - Test, test, test

11. Making Selection Pathway More Viable Improvements - Relevant choices - Less is more - Link quality, not value - Link out of pocket $$ - More information - Test, test, test

12. Making Selection Pathway More Viable Improvements - Relevant choices - Less is more - Link quality, not value - Link out of pocket $$ - More information - Test, test, test

13. Making Selection Pathway More Viable Improvements - Relevant choices - Less is more - Link quality, not value - Link out of pocket $$ - More information - Test, test, test

14. Making Selection Pathway More Viable Improvements - Relevant choices - Less is more - Link quality, not value - Link out of pocket $$ - More information - Test, test, test

15. Making Selection Pathway More Viable Improvements - Relevant choices - Less is more - Link quality, not value - Link out of pocket $$ - More information - Test, test, test

16. Do Consumer Need to Respond? Reputation

17. Making Reputation Pathway More Viable Key points • Focus on reputation • Choice not patient relevant • More complex data • Focus on high cost providers Care for Myocardial Infarction

18. Making Reputation Pathway More Viable Key points • Focus on reputation • Choice not patient relevant • More complex data • Focus on high cost providers Infarction

19. Making Reputation Pathway More Viable Care for Myocardial Infarction Key points • Focus on reputation • Choice not patient relevant • More complex data • Focus on high cost providers

20. Making Reputation Pathway More Viable Care for Myocardial Infarction Key points • Focus on reputation • Choice not patient relevant • More complex data • Focus on high cost providers

21. Making Reputation Pathway More Viable Care for Myocardial Infarction Key points • Focus on reputation • Choice not patient relevant • More complex data • Focus only on high cost providers

22. Key Take Aways • In current form cost measures unlikely to have the desired impact • Consider which pathway on which to focus • Impacts presentation, choice of measures, link to quality, and financial incentives • Limited scientific evidence base on consumer response

23. Acknowledgements • Co-authors • Judy Hibbard • Arnie Milstein • Peter Hussey • Paper written for AHRQ National Summit on Public Reporting for Consumers • Questions • AteevMehrotra • mehrotra@rand.org