Harvard Pilgrim pushes consumer directed care agenda

Managed care company Harvard Pilgrim HealthCare has a problem. For competitive reasons it has no choice but to pay for care at the well-known downtown Boston teaching hospitals, which have an excellent reputation. But those hospitals are expensive and use their position in the market to squeeze higher rates out of Harvard Pilgrim and others.Harvard Pilgrim CEO Charlie Baker is convinced that in many cases, quality is as good or better and costs are lower in community hospitals. He's been looking for ways to get patients to choose these hospitals and he hopes that consumer directed health plans coupled with better cost and quality information is the way to make it happen.To support its strategy, Harvard Pilgrim conducted a study (aka a poll) of doctors and consumers, which was reported in today's Boston Globe. (Doctors, patients want data on cost, quality, study finds) According to the study:

86 percent of consumers said they would be likely to ask their doctor to change hospitals for one that offers better-quality care at a lower cost for a routine surgery, like a knee replacement. About half of patients whose first choice is a teaching hospital would be willing to consider changing facilities if they had cost and quality data.

Apparently the pharmaceutical industry isn't the only one that can design a study to come up with what the sponsor wants to hear.There are significant barriers to achieving the kind of change the study implies:

• There's a need for better data. The costs are known, but quality is still defined imperfectly and will be for a long time
• There's a need for timely data. When a hospital scores poorly in reported data, it always claims that the current results are much better. Sometimes it's true
• There's a need to present data in a way that's understandable. Some of the ratings are too complicated to interpret, which is my sense of what's happening with IVF. Some are too simplistic, like the new state sponsored rankings for Massachusetts (which still doesn't mean it's easy to download or understand)

As we often read, there's plenty of data available on cars, appliances, and restaurants, but not health care. However, consumers aren't slaves to the data in those markets either. Plenty of people make a purchase without consulting the data or if they look at the ratings they may still buy something else based on style, peer pressure, or for no discernible reason at all.

It's one thing to read that knee surgery is better and cheaper at Small Town Hospital than at MGH, but quite another for consumers to act on the data to bail out Charlie Baker.