Fixing the nation's broken healthcare system is clearly contingent on the strategic use of data aswell as transparent cost and quality information across the medicalsupply chain, several industry thought leaders suggested during arecent BenefitsPRO webcast, “The Future of Transparency: Can Data Fix HealthCare?“.

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But realistic expectations are needed along the way to achievingbetter results. Asked about President Trump's latest executiveorder requiring hospitals to disclose their prices, for example, EPowered Benefits Founder and CEO David Contorno soundedskeptical.

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“What we need desperately is an improvement in quality and adecrease in cost, and I can't find one example of something ourgovernment has taken over in which that has occurred,” he toldattendees.

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Related: Can transparency change the US health care system?— With Ralph Weber

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Contorno, who was part of a committee that helped formulatelegislation with this intent in mind, cautioned that any sucheffort to achieve transparency could look very different afterindustry lobbyists weigh in and a bill gets to the floor of theSenate and House. He also noted how difficult it is to disclosepricing when “every hospital probably has 30 to 100 differentprices for the exact same thing… Which of those prices are theygoing to publish?”

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Crunching the numbers

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Irrespective of government intervention, he believes anysubstantive fix “is going to come from brokers and consultants, andthereby, ultimately, employer demand.” It starts with data miningand ends with meaningful measures, he added.

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“I think in order to leverage the data, you have to be able toget the data,” said Lester Morales, CEO of NextImpact, LLC, which recently branded a new data-driven solution forbrokers and advisors to offer their employer clients calledTransparent Health Benefits. He suggested that industry producersstipulate in their requests for proposal the terms under whichvendors must provide data for their clients.

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“If they win the business and therefore then sign the contract,it is now a contractual obligation for them to get the data,” heexplained.

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That scenario would have been very helpful for Walmart, whosehealth insurance carrier rebuffed the world's largestbrick-and-mortar retailer when it requested that thebottom-performing 3 percent of doctors be removed from its network,Contorno said. The official response was that doing so would haveviolated contractual terms, a troubling pattern seen with BUCAHplans that have been criticized for being stingy about sharing evendata collected in aggregate form.

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Jim Blachek, co-founder and principal of TheBenefits Group, LLC, recalled how a 175-life self-funded client'scarrier issued the same denial. “It just blew my mind,” he said.“The employer felt that they should have access to the data, but it's been like pullingteeth out of a chicken. They'd even gone to the extent of hiring aC-level employee at $90,000 a year to be able to manage thatdata.”

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These examples could be a reflection of where the industrycurrently stands. The fact is that employee benefit professionalshave been slow to implement push-button use of informationtechnology to scrub employee data as well as garner more meaningfulinsight and measurement, according to Grant Gordon, CEOof Artemis Health, sponsor of the webcast, which wasmoderated by Eric Silverman, founder of VoluntaryDisruption.

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“It's hard to tell if your programs are working or not,” hesaid. “There's just a ton of friction here, and I think there's anew generation of data companies that are trying to change thegame.”

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Lowering the cost of health care is contingent on controllingthe frequency and severity of claims, Morales noted. For example,he cited a $50,000 difference between the per-employee-per-yearcost of a diabetic who complies with treatment protocols and anoncompliant diabetic. If seven such plan members are involved,Morales said “we're talking about $350,000 of claims cost you couldmanage, not by eliminating that person from being a diabetic, butby getting them to be a compliant diabetic.”

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The frequency of procedures performed at health care facilitiesis also a key metric to consider when assessing outcomes. Contornoworked with a network of precision gynecological surgeons, all ofwhom do a minimum of 300 hysterectomies a year. “They have 90percent plus laparoscopic rate, and we have a bundled case ratewith them of $11,000 versus the average of $38,000,” he said. Thatamount includes any postoperative complications of follow-upcare.

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“It's important that health care data be used to drive quality,which will lower the cost of care,” said Blachek. He added thatemployers must “act on the data before conditions get to a pointwhere quality of life is diminished.”

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