Transparency: Foundation for a new health system

Transparent (trānspârent) adj.
  1. Capable of transmitting light so that objects or images can be seen as if there were no intervening material.
  2. Easily seen through or detected; obvious.
  3. Free from guile; candid or open.

Everyone recognizes that the United States has the potential and promise to deliver the best healthcare in the world. We spend more per capita than any other nation, yet our healthcare outcomes don’t even place us in the top ten of industrialized nations, our citizens get the right treatment only about 50% of the time, and patients remain disconnected and unaccountable for their own health. In addition, 45 million of our citizens have no insurance, the emergency rooms are busting at the seams, and the growing healthcare crisis has risen as the top issue for politico’s, CEO’s, and average Joe’s.

That’s about to change. It has to.

Led by former Utah governor Mike Leavitt, now the Chief of the Human Health Service (HHS), the government is looking to catalyze a systemic change within the healthcare system. I say “catalyze”, because Mr. Leavitt has appropriately acknowledged that, “only consumers and health-care purchasers, including businesses, acting together can change the system“. He has been quite successful in pitching the concept dozens of publicly traded companies who are voluntarily agreeing to support and adopt the new healthcare paradigm.

The prescription for change has four cornerstones, cemented together around a single concept – transparency:

  • Connecting the System: Every medical provider has some system for health records. Increasingly, those systems are electronic. Standards need to be identified so all health information systems can quickly and securely communicate and exchange data.
  • Measure and Publish Quality: Every case, every procedure, has an outcome. Some are better than others. To measure quality, we must work with doctors and hospitals to define benchmarks for what constitutes quality care.
  • Measure and Publish Price: Price information is useless unless cost is calculated for identical services. Agreement is needed on what procedures and services are covered in each “episode of care.”
  • Create Positive Incentives: All parties – providers, patients, insurance plans, and payers – should participate in arrangements that reward both those who offer and those who purchase high-quality, competitively-price health care

You will notice that each one of these initiatives represents a shift in power, with information being delivered to the person who ultimately should have the balance of power within a capitalistic society – the consumer (in this case the patient). From creating the interoperability standards that will allow the secure, efficient transfer of between patients-providers-payers; to distributing information to patients that enables them to become rational consumers of healthcare; to aligning financial reimbursement models that create incentives for best practices and reward best outcomes are all forms of patient empowerment. This is the foundation for the consumer directed healthcare revolution we keep hearing about

Transparency as a principle of change, and as a source of innovation, is a new concept within healthcare. Accelerating innovation by doing things out in the open, within a collaborative framework, based on agreed upon standards, while seeking best practices and best outcomes seems to building on the very powerful innovation model that is open source. As applied here, and has been so within medicine for hundreds of years, collaborating in a transparent fashion can not only be the source of but the power behind the required healthcare transformation.

It seems that shining the light, by sharing the information, can lead the way.

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