The Tug-of-War Over Health Care Data

Brian Klepper

Last week Anna Wilde Mathews at the Wall Street Journal published a nice piece that detailed the difficulties employers and consumers have getting meaningful health care data from health plans. As the article describes, that lock has been pried loose a little as a result of competition from health care data vendors like Castlight, Thomson Reuters and Healthcare Blue Book.

The health plans, particularly, are loathe to release any data that might reveal their pricing arrangements with providers, and they’ve used the protection of this proprietary information to justify continued data opacity, even though that information could be helpful to their employer clients and members as they try to cost-effectively negotiate the labyrinthine health care system.

We’re in a regulatory environment that has been neutralized, shaped largely by the organizations that would be regulated, and which, if it promotes transparency at all, does so grudgingly and with hurdles. Witness the open letter to Don Berwick, MD, CMS’ Administrator, by Bruce Boissonnault, the savvy, experienced CEO of the Niagara Quality Care Coalition in New York, decrying the tremendous barriers CMS has established that thwart organizations trying to access and analyze Medicare data.

Meanwhile, legacy health care organizations that work to maintain artificially high cost through protectionist maneuvers are really creating market vacuums that, in economically stressed times like the present, are highly susceptible to attack. We see this in the efforts of the health care data firms, and in my own onsite clinic/medical management sector, where we’re driving down cost significantly at the expense of the status quo. In the absence of public policy that is in the common interest, the market may not be as capable as we’d like, but it can sometimes be effective.

In other words, change is inevitable here, and soon.

Primary Care in Revolt

Brian Klepper

Last Thursday Anna Wilde Mathews of the Wall Street Journal ran an article detailing the activities surrounding primary care’s gradual awakening and mobilization. With Tom McGinty, Ms. Mathews authored a damning expose on the RUC last October that precipitated our efforts on against CMS’ 20 year reliance on the AMA’s RVS Update Committee (RUC) for valuation of medical services.

Continue reading “Primary Care in Revolt”