Data Needed for Consumer-Driven Health Care to Work


WASHINGTON — Consumer-driven health care may be the "next big thing" in health insurance, but it won't go anywhere until more data on plans, providers, and outcomes become available, George Halvorson said at a health care congress sponsored by the Wall Street Journal and CNBC.

"It's time for an industrial revolution in health care," said Mr. Halvorson, chairman and CEO of Kaiser Foundation Health Plan, Oakland, Calif. "We need to set a much higher standard for ourselves as an industry."

Many major and expensive trends in care "too often lack scientific backing," citing the examples of hormone therapy for heart attack prevention in women, knee surgery to relieve osteoporosis pain, and cyclooxygenase-2 (COX-2) inhibitors for arthritis pain, where the therapy turned out not to work as well as expected. "These are significant issues. Because there's no consistent database in health care, people did not realize this kind of outcome was happening with something that was a very popular treatment," he said.

Mr. Halvorson recommended that health care executives follow the example of other industries that have turned themselves around. For example, General Electric instituted a program of "measure, analyze, improve, and control" to weed out errors in its manufacturing process.

Health care doesn't do any of those four steps with any great consistency, Mr. Halvorson continued. "Where does health care get the data that are used? We get it from paper medical records, which are not even complete per patient." For instance, he said, "we have one patient, four doctors—four unrelated, unconnected, noncommunicative, nonintuitive, noninteractive, too often inaccessible, and often illegible, paper medical records from which to derive the database."

In addition to well-known data-collection tools such as electronic medical records (EMRs) and computerized physician order-entry systems, the health care system also should systematically collect other information, such as whether patients fill prescriptions, Mr. Halvorson said.

Although the United States health care system is better than it's ever been, and the technology is better than it has ever been, "we will not be able to realize the full potential of it until we can get an information flow, and the flow has to come from an EMR," Mr. Halvorson said. He added that a single nationwide EMR system would not be necessary as long as local systems could transport data to one another if needed.

To make data collection part of the national agenda, the impetus needs to come from a large government program like Medicare. "Medicare is the key, and hospitals are the leverage point," he said. "Medicare accounts for about 40% of hospital revenue. If Medicare decided to do this, it could make this happen with a rewards system … relatively quickly. Investment dollars are needed, and Medicare needs to support that."

Next Article: