STRATEGIC PLAN - ASPE - U.S. Department of Health and Human ...

CHAPTER 2: Health careHealth Care TransparencyHealth care transparency may restrain the growth ofhealth care costs because consumers will know thecomparative costs and quality of their health care—andthey will have a financial incentive to seek out qualitycare at the lowest cost. Consumers will gain controlof their health care and have the knowledge to makeinformed decisions. Health care transparency is builton four interconnected cornerstones:• Connect the System. Every medical provider has asystem for keeping health records. Increasingly,those systems are electronic. Standards need tobe identified so that all health information systemscan quickly and securely communicate andexchange data.• Measure and Publish Data on Quality. Every case,every procedure, has an outcome. Some outcomesare better than others are. To measurequality, HHS must work with doctors and hospitalsto define benchmarks for what constitutesquality care.• Measure and Publish Data on Price. Price informationis useless unless cost is calculated foridentical services. Agreement is needed on whatprocedures and services are covered in each “episodeof care.”• Create Positive Incentives. All parties—providers,patients, insurance companies, and payers—should participate in arrangements that rewardboth those who offer and those who purchasehigh-quality, competitively priced health care.Employers committing to these cornerstones wouldagree to collect quality and price information throughits health plan or benefit administrator, using theconsensus standards. Employers committing to thegoals also would be encouraged to share quality andprice information with regional collaboratives, whereinformation from many sources could be aggregated,thus producing the most broad-based and reliableinformation possible. The employer or its health planwould share quality information with enrollees andwould provide specific costs the enrollee would expectto pay under the plan.Six pilot programs to demonstrate how transparencycan promote improvements in health care areunderway, with support from CMS and AHRQ. Thesepilot programs are being coordinated under the BetterQuality Information Data Aggregation and Reportingproject, through a contract with the MarylandMedicare Quality Improvement Organization. Thecommunities were selected using a set of criteria by arepresentative committee of the public/private entityAmbulatory Care Quality Alliance, which consists of135 physician organizations, consumers, employers,and health plan representatives. The Alliance makesavailable quality information about physician care. Thepurpose is to measure and report on physician practicein a meaningful and transparent way for consumersand purchasers of health care.Personalized Health CareThe future of health care in America is one in whichcare will be personalized, predictive, preemptive,and participatory. Advances in basic research havepositioned us to begin to harness new and increasinglyaffordable potential in medical and scientifictechnology. With clinical tools that are increasinglytargeted to the individual, our health care system cangive consumers and providers the means to makemore informed, individualized, and effective choices.Emphasis on personalized health care could makehealth care safer and more effective for every patient,especially when we are able to use the power of geneticinformation and health information technology tobetter understand each patient’s needs and moreprecisely target therapies. This may mean that thesame medical condition requires different treatmentfor men and women, or for older persons, or for otherswhose inherited traits may put them at particular risk.Ongoing activities across HHS are working toward thelong-term goals of personalized health care, and theconvergence of these efforts will act as a powerful forceto educate both the patient and the health care providerto improve clinical outcomes. Basic research at NIH isimproving the foundational knowledge of diseases; FDA’sCritical Path Initiative is improving the speed and safetyof product development; and CDC will use populationdata to understand the genetic basis of diseases.40 HHS Strategic Plan FY 2007-2012