PROVIDING VISIBILITY & UNDERSTANDABILITY TO TRANSPARENCY

1. PROVIDING VISIBILITY & UNDERSTANDABILITY TO TRANSPARENCY The Sixth Annual Quality Colloquium 20 AUGUST 2007 Richard Weiss, MD, MPH, MMM, PMP Medical Vice President MAXIMUS Federal Services Action expresses priorities. Mahatma Gandhi

2. President George W. Bush Executive Order of August 22, 2006 This Executive Order Directs Federal Agencies That Administer Or Sponsor Federal Health Insurance Programs To: 1. Increase Transparency In Pricing. 2. Increase Transparency In Quality. 3. Encourage Adoption Of Health Information Technology (IT) Standards. 4. Provide Options That Promote Quality And Efficiency In Health Care. http://www.whitehouse.gov/news/releases/2006/08/20060822-2.html retrieved 17 February 2007

3. U.S. Department of Health & Human Services • Four Cornerstones Initiative • Issued by Secretary Michael Leavitt • Call to Employers to Commit to 4 Goals • IT Connectivity • Quality Reporting • Price Transparency • Choose Care Based Upon Value

4. TRANSPARENCY The Quality or State of Being “Transparent” Transparent 1 a (1): having the property of transmitting light without appreciable scattering so that bodies lying beyond are seen clearly 2 d: characterized by visibility or accessibility of information especially concerning business practices Merriam-Webster Online Dictionary, retrieved 17 February 2007

5. REQUIREMENTS FOR TRANSPARENCY • Visibility • Accessibility • Understandability • Minimal Bias While Transforming Data to Information • Even if you are a minority of one, the truth is the truth.

6. VISIBLE?

7. ACCESIBLE?

8. UNDERSTANDABLE?

9. ADDITIONAL FORCES AGAINST TRANSPARENCY • “Bad Data” • Doctors – Historically • Facilities – Historically • NY Attorney General Request July 2007 Constant development is the law of life, and a man who always tries to maintain his dogmas in order to appear consistent drives himself into a false position.

10. RISKS OF TRANSPARENCY • Self-Protection • Lack of Will • Litigation • Perceived Expense • Wrong Data • Health Care Policy Takes Wrong Turn Healthy discontent is the prelude to progress.

11. TRANSMITTING LIGHT WITHOUT APPRECIABLE SCATTERING • Inherent Bias in Gathering Data • Incomplete Data • Expense of Obtaining Data • Inherent Bias Transforming Data to Information • Adjustments (Risk, Payer) • Presentation Format • Data Absent Analysis? • Information Without Data? • Data and Information?

12. FORCES FAVORING TRANSPARENCY • The Trojan Horses • P4P • Client-Directed Health Care • Health Savings Accounts (MSAs) • Value-Based Purchasing • Fully-Informed Consent • Purchasers • Consumers • Patient Advocates: Nurses & Other HCPs • Providers • International Comparisons

13. IMPROVING VISIBILITY & ACCESSIBILITY

14. CENTER FOR HEALTH LITERACY • Literacy • Understandability • Consumer Decision Aids • Design Be the change that you want to see in the world

15. COST TRANSPARENCY URLs • Population (Cost of Health Care) • Payer • Individual • Hospitalization • Elective Surgery • Clinicians • Pharmaceuticals • Not Episode of Care

16. QUALITY TRANSPARENCY URLs • Individual • Population • Ambulatory Care-Sensitive Conditions • Disease Prevalence Rates • Prematurity Incidence Rates • Death Rates/Average Age to Survival • Cost of Health Care

17. INDIVIDUAL QUALITY TRANSPARENCY URLs • Facility-Based Mortality Data • Surgical Procedures • DRG or Disease-Specific • Other Facility-Based Measures • ORYX Core Measures • AMI, HF, PN, SCIP • Readmission Rates • HEDIS-like Data

18. JUNE 2007

19. AUGUST 2008? Be the change that you want to see in the world.

20. REALITY HEALTHCARE • Fantasy Sports • Statistically-Based • $5+ Billion per Year Industry • Reality Healthcare • $0.00 per Year Activity Happiness is when what you think, what you say, and what you do are in harmony.

21. POINT OF CONTACT • Richard Weiss, MD, MPH, MMM, PMP • Medical Vice President • MAXIMUS Federal Services • 1600 E. Northern Ave, Suite 100 • Phoenix AZ 85020 • 602-308-7160 office • richardweiss@maximus.com Live as if you were to die tomorrow. Learn as if you were to live forever.

22. PRICE TRANSPARENCY URLsSTATES • Arizona Department of Health Services www.azdhs.gov/plan/crr/cr/cmparison_reports.htm • California Office of Statewide Health Planning and Development • www.oshpd.cahwnet.gov/HQAD/Hospital/Chargemaster/2005/ • Florida Agency for Health Care Administration www.floridacomparecare.com • Maryland Health Services Cost Review Commission Mhc.Maryland.gov/consumerinfo/hospitalguide/hospital_guide/docs/ • Massachusetts Office of Health and Human Services www.mass.gov • Rhode Island www.health.state.ri.us/chic/statistics • Utah http://health.utah.gov/had/ • Washington Department of Health www.doh.wa.gove/EHSPHL/hospdata/

23. PRICE URLs (cont)State Hospital Associations • State Hospital Associations • Iowa www.ihaonline.org/links/ppintro.shtml • Louisiana www.lahealthinform.org • Massachusetts www.mahealthdata.org • Minnesota www.mnhospitalpricecheck.org • New Hampshire www.nhpricepoint.org • New Mexico www.nmpricepoint.org • Oregon www.orpricepoint.org • Texas www.txpricepoint.org • Utah www.utpricepoint.org • Virginia www.vapricepoint.org • Wisconsin www.wipricepoint.org

24. PRICE URLs (cont)Commercial (examples) • Empower Benefits – patient’s out-of-pocket cost as inpatients www.empoweredbenefits.com/products/carecost • Vimo – hyperlinks to several other sites, information on prices for hospitals, and negotiates for patients or payers www.vimo.com • My Medical Control – analyzes patient bills, settles claims with providers, charge 35% of savings www.mymedicalcontrol.com • Health Plan Sites – for plan enrollees only • Spectrum Health www.spectrum-health.org • Humana www.humana.com • WellPoint www.anthem.com • HealthPartners www.healthpartners.com • Medica www.mymedica.com

25. PRICE URLs (cont)Others • University of Manitobawww.umanitoba.ca/centres/mchp/reports • NICHSR www.nlm.nih.gov/hsrinfo/datasites • DHHS – CMS www.cms.hhs/gov/HealthCareConInit/ • Hospitals for common elective inpatient procedures and • 30 most frequent DRGs • 11 other conditions • Common outpatient procedures performed in a hospital • Ambulatory Surgery Centers • Payment for physicians’ services • HHAwww.hhs-stat.net/TNICHSR

26. QUALITY TRANSPARENCY URLs: STATES • Arizona Department of Health Services www.azdhs.gov • California Office of Statewide Health Planning and Development • www.oshpd.cahwnet.gov/HQAD/outcomes/ • Florida www.floridacomparecare.gov/ • Maryland Health Services Cost Review Commission • Massachusetts Office of Health and Human Services • www.mahealthdata.org • New Mexico www.nmcheckpoint.org • Rhode Island www.health.state.ri.us/chic/stats/ www.healthri.org • Utah www.health.utah.gov/ • Wisconsin www.wicheckpoint.org/reports

27. QUALITY URLs (cont)Others • Henry J. Kaiser Family Foundation • www.statehealthfacts.org • All 50 states, population health, HEDIS-like factors • Organisation for Economic Co-operation and Development www.oecd.org • Iowa Healthcare Collaborative • www.ihconline.org • Statistically above, below, or at statewide mortality rate (filtered) More than 30 cases/year

28. QUALITY URLs (cont)Commercial Products (examples) • American Association of Retired People • www.aarp.org/bulletin/yourhealth/statebystate_guide_healthcare_provider_performance • Filtered Information Products • The HealthLine Project www.atkosoft.com/Projects/healthline • WebMD www.webmd.com • Revolution Health www.revolutionhealth.com • Health Plan Sites – for plan enrollees only • Spectrum Health www.spectrum-health.org • Humana www.humana.com • WellPoint www.anthem.com • HealthPartners www.healthpartners.com • Medica www.mymedica.com