Faced with the alarming implications of health care spending growth and suboptimal quality, many nations are turning to market-based reforms. The United Kingdom recently empowered primary care physician groups to choose among competing specialty care providers for their patients. In the United States, payers are introducing tiered copays, making patients pay more to visit what payers deem high-cost or low-quality providers. Even Sweden has introduced choice and competition in areas such as knee replacement and spinal surgery to curb the tide of rising costs.
The rationale behind these reforms is compelling and age-old: competition will unleash innovation, lower costs, and boost quality. But in health care, this logic hasn’t held, and largely for one simple reason: we do a terrible job of measuring, disclosing, and competing on the things patients actually care about: their survival, quality of life, and rates of complications after care.
Beneficial competition is rooted in informed choice. For competition to achieve its promise of incentivizing higher-value health care, patients and payers must first be able to determine and elect higher value options — providers who deliver better outcomes at the same or lower costs. Providers, meanwhile, must be able to benchmark their own performance against peers to find and adopt innovations that deliver improved outcomes for patients.
But this foundational aspect of competition is almost entirely lacking in health care today. So opaque is the market that physicians too profess ignorance when thrust into the role of health care consumer. “[E]ven a doctor doesn’t have much to go on when it comes to making a choice,” lamented surgeon and writer Atul Gawande as he sought a provider for his mother’s knee replacement. “A place may have a great reputation, but it’s hard to know about actual quality of care.”
Changing this element of health care is the single most important step we can take to set health systems on a sustainable path. And it is possible. The simple logic of making transparent the actual outcomes of care has already animated a host of efforts that have had profound impact on quality of care.
The Cystic Fibrosis Example. Perhaps the best known example is that of cystic fibrosis, a debilitating genetic disease that impairs breathing and digestion. In the 1950s, CF was a death sentence. The average patient did not see her sixth birthday.
Today, it is a chronic condition with which patients can survive into their 40s, 50s, and longer. In large part this reflects the fact that, because of the work of the Cystic Fibrosis Foundation and a handful of pioneering physicians, CF is one of the few conditions for which centers reported patient-focused outcomes measures — their patients’ lung function and survival data. The revelation that some centers were getting substantially better results propelled a process of innovation and improvement that has added decades to the lives of CF sufferers.
ICHOM: putting the focus on outcomes measurement. Inspired by such successes, we have joined together to form the International Consortium for Health Outcomes Measurement (ICHOM), a nonprofit that will bring together leaders from the world’s best outcome measurement efforts along with payers, patient advocates, and other health care stakeholders. Our immediate aims are threefold: first, to share how leading providers measure clinical outcomes; second, to use this information to enable international standardization of measurement by condition; and third, to promote development of systematic outcomes measurement. As part of these efforts, this morning we launched a searchable open-source database built from 55 of the world’s best disease monitoring efforts in 20 countries, covering 16 conditions from coronary artery disease to cataracts.
Our broader goal is to put outcome measurement on the agenda for health care reform efforts worldwide. The problems facing health care reach beyond national borders, across regions and cultures. In every nation today, patients, payers, and even providers largely lack the most basic risk-adjusted outcome information needed to identify excellent care. But those pockets of health care that have adopted outcome measurement show us the transformational potential for transparency and choice to drive higher-value health care.
Governments and payers the world over are looking for answers on health care. The status quo of health care spending growth is unsustainable, and unchecked it will lead to rationing of care. And more is at stake here than just health care—the current growth in health care costs threatens to crowd out education, social programs, and non-health care consumer spending.
A call to policymakers. We urge policymakers to begin their efforts by fostering the measurement and reporting of health outcomes. Without this infrastructure, other important reforms will be trapped within the confines of today’s health care system, where true competition and rapid improvement are stifled. But if nations place outcome measurement at the top of their reform agendas, they can begin to unlock forces of innovation and improvement that may yet help us realize the dream of financially sustainable, high-quality health care.