Opinion: 6 ways to modernize federal health data policy

Healthcare costs are off the charts, making it crucial for consumers to choose the right health plan with the right healthcare provider for their medical needs. That need has helped create a fast track to rising consumerism in healthcare, supported by improved tools via data and information technology, new plan designs, and the growing role of online comparison shopping in our everyday lives. 

Yet, there are obvious signs that the market and governments have been too slow to adapt to the changing dynamics and growing demand for health care transparency.

The confused consumer

Consumers often lack the level of health literacy and access to cost and benefit information needed to make optimal choices. For example, more than 70% of participants in a Carnegie Mellon study failed to pinpoint basic cost-sharing specifics of their health plans, such as the significance of a deductible or the difference between copayments and coinsurance.

Another study, conducted by a Columbia business professor, showed equally startling results, finding that whether a consumer will pick the lowest-cost plan is essentially a toss-up. Only 21% were capable of the task, “a figure not statistically difference from chance.”

These discoveries highlight how inadequate information makes for poor health plan choices. The wrong healthcare choice leads many consumers to overpay for health plans that underdeliver for their particular needs.  

Better access to cost and benefit information can help. Done well, changes to improve transparency can offer a huge pay-off. According to Don Berwick, the former administrator of the Centers for Medicare and Medicaid Services, the lack of transparency and competitive pricing accounted for between $84 billion and $174 billion in wasteful spending last year. While transparency, by itself, will not cure all that ails our uncompetitive healthcare system, it is a good place to start.

An agent of change

Any positive change will require better and more data. Unfortunately, federal data policy suffers from a lack of normalized, trusted, and sharable data across programs and providers. Federal policymakers are compounding the problem by missing opportunities to reform how data is reported, collected and used. Capitalizing on these opportunities will help contribute to better data, better tools, and better markets for consumers making decisions about their healthcare and coverage. For example, federal health programs still allow for information blocking by electronic health record (EHR) vendors. Medicaid and the Children’s Health Insurance Program’s (CHIP) claims and quality data are reported inconsistently across states. Quality measures used in federal programs aren’t relevant to the specialists who must report them. And data are dumped into the marketplace without the critical context that would allow consumers to use those data and make proper decisions.

These problems are big, but solvable. Decision makers pursuing effective management of federal and state programs must increasingly keep up with the latest tools, trends, and capabilities.

Internal server error