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Regina E. Herzlinger

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Finding the Truth about Health Insurers: Mission Impossible?

Posted: 05/12/10 04:36 PM ET

All of us should know the quality and cost of health insurers; but this information is especially essential for the 34 million people who will newly shop for plans under the health reform legislation -- essential, but not available.

Should not someone with breast cancer know how current enrollees and their doctors ranked the insurer's responsiveness to people like her and how good their doctors and hospitals are? Why are we not informed about the service risks posed by the insurer's financial situation? Although I have been a member of the Board of Directors of many health care organizations and am an experienced accounting and health care professor, even I cannot easily find the answers to such questions.

The difficulty was dramatized for me recently when I was informed that the Nominating Committee of WellCare Health Plans, Inc. -- a Medicare and Medicaid managed care firm -- had chosen not to renominate me. I resisted this decision -- not because sitting on the Board was enjoyable -- but because of my concern for the welfare of our shareholders and vulnerable enrollees: The company had the lowest Medicare quality scores and the most fines and sanctions recently among its peers and, as the Chair of the Audit Committee. I knew just how fragile its accounting system was.

I was advised that if I quietly sat out the remainder of my term, rather than publicly resigning, nearly $150,000 worth of unvested shares would be mine. Many directors, faced with these circumstances and their exposure to the bottom-feeding bloggers who feed on public disclosures, would accept the advice. But I was so concerned about the firm's shareholders and enrollees that, instead, I spent considerable effort gathering information about the firm's worrisome quality and financial issues which I included in my publicly disclosed resignation.

But wait a second -- why is a public resignation by a fed-up director one of the few ways to publicize information which everyone should have readily available?

If H.R. 4803, the bipartisan Rep. Barton-Green-Burgess-Stupak Patients' Right to Know Act and Rep. Steven Kagen 's (D-Wis) complementary bill, are passed, this kind of information will be readily available to all. The bills' uniquely bipartisan backing indicates that members of the U.S. Congress were willing to rise above their differences when it comes to transparency.

This legislation would force disclosure of which insurance companies and policies provide the most medical-care benefits and best outcomes per dollar, offer the best doctors and hospitals, and hassle sick people and their caretakers the least. If insurers with lackluster scores do not improve, competitors would enter this surprisingly entrepreneurial market. (The leading providers of high-deductible insurance, for example, were formed only nine years ago.)

Transparency's benefits would also extend to our out-of-control health care costs. The U.S. Congressional Budget Office (CBO), for example, estimated billions in Medicare savings, from 2010 to 2019, from the increased utilization of regional centers of excellence for surgery, which transparency would likely spur. Further, the mere act of providing data motivates providers to change, a phenomenon known as "the audit effect." The CBO, for example, estimated that sharing peer-profile scorecards with physicians would also save Medicare billions.

Can transparency be obtained through voluntary efforts? Obviously not. Instead of backing transparency, most health-care participants raise objections, including consumers' lack of interest and the allegation that transparency's costs will exceed its benefits, and that the measurement of quality is infeasible. But the many benefits of transparency trump its costs. And although health-care transparency measures are not as yet well developed, with time they will be.

The problem is not that Americans aren't interested in transparency. They rated it as the number one health care reform they want from the government. The problem is that Americans do not have the health care transparency they need.