The Dark Side of Data Transparency

ANALYST PERSPECTIVE - Making provider-cost and quality information available to consumers is perceived by employers and payers as one of the key strategies towards achieving cost containment. The premise is that an informed consumer will make better decisions about where to go to receive certain healthcare treatments or will select physicians who have better outcomes and/or are more cost effective than their colleagues. But is this always the case? Or is healthcare really different?

Today's Internet-savvy consumer is very familiar with online rating systems. One can rate ahotel, restaurant, book, music CD or practically any other consumer good on numerous websites. There are now a number of third party sites offering rating systems for physicians and hospitals. Representative examples include:;;; and (a site run by The Joint Commission). Health plans are developing their own sites or partnering with third party content providers. State medical societies have also begun to provide consumers information about physicians' malpractice and disciplinary action history.

addition to rating things like bedside manner, ability to make a timely appointment, and staff courtesy, some sites also allow patients to provide their own commentary about their experience with the physician or hospital, much like a book or restaurant review. Health plan sites are also assessing quality by analyzing member claims data for adherence to best medical practices. Many physicians, and some consumers, are skeptical about the validity of the results.

Blue Cross Blue Shield of Texas suspended BlueCompare, its physician rating system that was
slated for a January 1, 2007 launch, after the Texas Medical Association (TMA) complained about the accuracy of the data. Representatives from TMA stated that claims data does not tell the whole story. For example, a review of medical records would reveal patients who had been prescribed critical screening procedures, such as mammograms; instead the current system dings the physician for noncompliant patients.

Tiered networks which designate physician quality
and cost effectiveness have also come under attack. Regence BlueShield of Washington called off its "Select Network" when six physicians and the Washington State Medical Association filed a lawsuit against the health plan charging that its data and methodology for ranking physicians was flawed.

Effective communication is at the crux of these initiatives. Tiered network plans and rating
systems can be confusing to both providers and patients. Defining genuine quality metrics that are meaningful for both providers and patients is paramount. Health plans must work with physician leadership to ensure acceptance quality metrics if these plans are to be effective. Sites that allow consumers to post anonymous comments should be more closely monitored to prevent an unhappy patient from "flaming" a physician. Registration would also prevent consumers, or physicians for that matter, from attempting to inflate or deflate a physician's rating.

Over time
these rating systems will improve and thus increase the transparency of cost and quality. But, for now, consumers should use these sites as only one data point when deciding which physician or hospital to select.

Lynne is Research Director for Payer IT Strategies at Health Industry Insights, an IDC company, and can be reached at

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