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The Truven Health Blog


The latest healthcare topics from a trusted, proven, and unbiased source.


Price Variation with No Discernible Relationship to Quality or Outcomes


By Michael L. Taylor/Friday, August 16, 2013
Mike Taylor imageTina Rosenberg, a highly respected healthcare journalist for the New York Times, recently published a two-part “Opinionator” series on healthcare costs. The second article in the series discussed the Truven Health white paper from 2012 that describes the $36 billion savings opportunity due to price variation among providers. I was pleased to speak with Ms. Rosenberg about the topic, and provide background information for the article.

Our research (and others) has shown price variation based on geographic location, with some areas of the country charging much higher rates than others for similar services—and not demonstrating any significant improvement in quality or outcomes. Our white paper extends the research to show prices also vary within any given market, again without discernible differences in quality. As an example, a hospital charge for a similar procedure may vary by a two-fold difference, based on the discounts negotiated between the payer and the hospital.

Further, the Institute of Medicine (IOM) recently reported even more information on price variation and pointed out the value of price transparency. That paper argues that it would be a mistake for CMS to make significant pricing changes based on geographic principles alone. One of the major data sources? The Truven Health MarketScan® Research Databases, and one of the consultants working with IOM on this paper was our own Teresa Gibson, PhD.

This topic of price transparency helps understand how to improve the quality and decrease the price of healthcare—the stated vision of Truven Health Analytics. This is a tangible example of how we are fulfilling that vision.

Michael L. Taylor, MD FACP
Chief Medical Officer

Asking the Right Questions about the Necessity of a Cesarean Birth


By Michael R. Udwin/Thursday, July 11, 2013
Michael R. Udwin imageThe HealthLeaders Media article "C-Section Rate Reductions Panned" rightly applauds the drop in cesarean births prior to 39 weeks yet is unable to completely explain why such deliveries have continued to rise after 39 weeks. As suggested in the article, concern about large babies and the over-use of induction may be contributing to this phenomenon. Like so many other challenges facing the healthcare community, the key to changing outcomes rests in asking the right questions. Yes, this does sound like a cliché. But surprisingly, it is not happening often enough.

Those with access to healthcare data are in a unique position to pose and answer the right questions. Such queries could explore the indications for the surgery? How many cases started as inductions? And are these inductions “necessary?”

It is instructive and perhaps not coincidental that early elective deliveries declined as hospital rates were publicly published. This suggests that providers are indeed sensitive to patient perceptions and concerns. With this in mind, it is up to both doctor and expectant parent to not just pose the above questions but also adjust behavior based on the answers.

It is a common refrain in hospitals, “mothers come to have a healthy baby, not to have a natural delivery.” This is indeed true, but it does not preclude ideally doing both whenever possible.

Michael R. Udwin, MD, FACOG
National Medical Director

Data is More than Numbers When Addressing Quality


By Michael R. Udwin/Tuesday, July 9, 2013
Michael R. Udwin imageIn the July 2, 2013 edition, HealthLeaders Media stated "Healthcare Quality Metrics ‘Abysmal,’ Senate Panel Hears," and this article clearly highlighted the palpable frustration voiced by providers, payers and patients. How do we characterize hospital outcomes that would be meaningful to all three groups and most importantly drive best practices?
If the hospital CEO pronounced that we expect all care in the hospital to be the “best,” it would likely be met with applause and a shrug of the shoulders. Who would argue against such a goal? Yet, how do I, listening to that call to action, effectively contribute to this vision?

Of course, it begins with meaningful, actionable data that effectively captures the essence of both gaps in current performance and strengths upon which to leverage future efforts.  Recognizing that leadership often views success from 30,000 feet; change is accomplished one project at a time and by ensuring all stakeholders trust the data and believe he or she can impact the diagnosis or procedure in question.

No doubt the public confusion over healthcare information will persist in the short term. Competing safety measures, migration from process to outcomes metrics, and multiple means to “rate” care have lead to a spectrum of responses; from frenetic reflexive behavior to fearful cautious retreat. It is our call to action to ensure that data is more than just numbers; that it provides clarity to those delivering best practice and accurately reflects the standards of excellence we all expect as patients!

Michael R. Udwin, MD, FACOG
National Medical Director

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