A coalition of 28 large U.S. employers today announced they will mine data to create hospital and physician report cards around quality and cost measurements and distribute the information to their 2 million employees to create "a more open and rational" healthcare market.
Their Care Focused Purchasing initiative would glean data on hospital and physician performance from their own employee healthcare claims records, as well as from government and participating health plan databases.
Mercer Human Resource Consulting, which is providing staff support for the venture, issued a statement that the group has commitments from Empire Blue Cross and Blue Shield and Humana to supply data and expertise to the project. An Aetna spokeswoman said her company has had discussions with the coalition, but no decision has been made about joining their effort.
The use of claims data for measuring clinical quality is controversial because existing code sets, such as ICD-9-CM and Current Procedural Terminology, lack specificity.
"It's really tough," said medical informaticist Blackford Middleton, M.D., chairman of the Center for Information Technology Leadership, the Wellesley, Mass., institute he helped found with Boston-based Partners HealthCare.
"There's not only the data quality problem, there's the severity-adjustment problem, doctors saying 'my patients are sicker.' If they measure them by their claims data or any other secondary data, it's not going to be as good as clinical data."
Using claims data for clinical performance evaluations will produce "very fuzzy" results, Middleton said.
Another problem is the relative scarcity of clinical data in electronic form. The electronic medical records systems needed to collect it still are not in common use.
"There's just no widespread adoption," Middleton said. "In ambulatory care, the adoption is 20%, at best."
Arnold Milstein, M.D., is medical director of the Pacific Business Group on Health and a consultant with Mercer working with the project.
Milstein concedes Middleton's point about the data but argues that it is no reason not to get started.
"It's going to be good enough, but not great," Milstein said. "This is a situation in which the customers are going to do the best they can with the only information they have, which is billing information."
Milstein compares these first steps by the coalition with those taken by the National Committee for Quality Assurance with its 1991 rollout of the Health Plan Employer Data and Information Set, or HEDIS.
"At the beginning of HEDIS, there was a lot of whining and screaming," Milstein said. "Looking back on the first one, you could say, 'wow, that was primitive and imprecise.' But the way HEDIS got better fast was to be used in the market, and it got improved very quickly.
"The best way to improve measurement," Milstein said, "is to begin measuring and then work with those being measured to improve the measurements."
"What you're seeing right now is purchasers in a state of almost total quality blindness," he said. "We're way past due having a robust quality measurement system in place for doctors and for hospitals."
Sharon Leight, benefits director at coalition member J. C. Penney Co., in a prepared statement, said: "We think the current approach to purchasing employer health care benefits is not effective in delivering quality care consistently at an affordable price. We as employer purchasers and our employees don't have the information needed to make well-informed decisions about the best providers."
Other major employers in the group include Pepsi, Capital One Financial, Sears, Roebuck and Co., Sprint, Xerox and Texas Instruments.
Jean Chenoweth is executive director of the 100 Top Hositals program at healthcare data vendor Solucient, Evanston, Ill., She is the author of a recent report for the Governance Institute on the opportunities hospitals and physicians share with the growing demand for publicly reported quality and patient safety information.
Chenoweth said the latest employer effort is nothing new, and it won't be the last.
Hospitals have been publicly rated for a while, and several health plans and regional employer business groups on health, including Milstein's in California, have begun grading doctors at the group and individual levels, she said.
Still, she said, "Most docs are not aware how extensive this is. These efforts are going on independently all across the country. This is going to be a major issue for the physicians. It's not small, and it's going to grow. There will be a whole era of experimentation going on until some standards are devised."