May 10 2017 | 0 Comments | 104 reads Average Rating: 3

The More Consumers Know, the Better They Will Fare

by Dr. Kevin Keck in Population Health

Pricing and quality transparency takes on increased importance with high deductible plans.

Knowledge is power. Patients are likely to latch on to the idiom as high deductible health plans, which place more financial responsibility squarely on the shoulders of consumers, become more prevalent. Indeed, as patients take more financial responsibility for their care, they will want to know exactly what they are paying for.

The upshot? Healthcare organizations will need to leverage data analytics to provide the information that can help consumers:

1 - Understand what care services cost.

When patients are paying out of their own pockets for clinical care, they will demand pricing transparency. For instance, if a physician starts ordering lab tests and high-tech imaging studies, patients are not likely to simply go along for the ride. Instead, they are likely to stop and ask: “How much is this going to cost? And why do I need it?”

As a result, physicians will need to have a handle on what each service costs – something that they formerly did not need to bother with. In essence, physicians will need to act more like their counterparts who treat animals. Indeed, veterinarians are trained to advise pet owners on the costs of each and every procedure – as well as of the benefits associated with the procedure and the risks associated with foregoing it. For example, physicians will need to have the data to say that “this imaging test of your back costs $3,300 and you do this because we are looking to see if surgery will help you. The surgery, if done, will cost $66,000 and keep you out of work for three months. Your back pain is likely to get better over time but you must live with the symptoms as they gradually get better.”

2 - Comparison shop.

Consumers will want the information that enables them to weigh their options. For example, they will want to know that a certain procedure will cost them $500 from the provider down the street but only $400 from a doctor whose office is an hour’s drive away. With such transparency, the consumer can determine if the $100 savings is worth the hour’s drive and $10 in gas money.

3 - Assess quality.

Patients will also want to know what they are getting for their money. As such, healthcare organizations will need to provide information that answers questions such as: Which physician has the best quality outcomes? Which physician does the best in getting needed services accomplished? Which physician does the best in preventing hospitalizations for patients with chronic conditions?

4 - Make preference sensitive decisions.

Patients will want to be able to make decisions based on data that analyzes both outcomes and price – especially with treatments whose value is a gray area. For instance, patients will want to know what the expected outcomes might be before investing in services such as knee replacements or upper endoscopies. The demand for this type of analysis could start a consumerism element with “parachute” procedures – which many providers currently offer as the sole alternative (in other words, you have no choice but to jump out of the plane). For example, such analysis might reveal that medical therapy could lead to the same results for significantly lower costs than surgery for some patients who are experiencing hip or knee pain.

These are just a few of the ways that healthcare organizations will be called upon to leverage data analytics to produce the knowledge that will enable consumers to make better choices. There, of course, are many, many others.

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Author
Dr. Kevin Keck
Chief Medical Officer

Dr. Keck is SCIO’s Chief Medical Officer and leads the Clinical Analytics development team. His responsibilities include assessing the leakage and the impact of quality and cost in Provider Analytics.

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