THE BLOG
03/18/2010 05:12 am ET Updated Nov 17, 2011

Point 3: We Need an Orbitz for Health

We need an Orbitz for health.

We need consumers and patients in America to be able to make health care choices in a data-rich environment -- with clear information about care outcomes, caregiver performance, care effectiveness and price.

Health care reform should have a vision of real and meaningful choice.

Why do we need choice?

Because people's lives depend on it.

The difference in death rate between the best hospitals and average hospitals for the exact same patients is 52 percent. The difference in death rate between the best hospitals and the worst hospitals is over 70 percent. Shouldn't health care reform for our country set up a health care marketplace where consumers and patients can increase their personal chance of survival by more than 70 percent?

The absolute truth is that that a marketplace of informed choices will not happen unless the health care reform legislation being passed in Washington very carefully sets it up, and tees it up now.

There are major differences in both caregiver performance and care-team performance in this country. The best care teams continuously improve -- focusing on best science, best service and best care. Consumers don't know who those best care teams are in today's world.

Consumers, today, make decisions with almost no data and with very little ability to know how to make the best choices relative to care options, caregivers or care teams.

The new health care reform agenda in both the House Bill and Senate Bill calls for "exchanges." Exchanges are insurance purchasing mechanisms that can -- if they are set up well -- create meaningful choice between health plans and health insurers. Those exchanges could revolutionize American health care, if they are done well, because they can also create real and informed choices about the quality and outcomes of care.

Real competition between best caregivers and the best teams of caregivers can happen if those exchanges are set up appropriately and if the real goal is for the provider participants in the exchanges to compete in meaningful ways. The new exchanges could -- if we don't have the clear vision of better care -- become narrow, rigid and creativity-crushing local health insurance market bureaucracies, or they could be places where consumers get enough data to make real decisions and where health plans and insurers can succeed by having both the best price and product.

People need and deserve choices.

Patients with stage three pancreatic cancer should know which oncology groups have the best survival rate for this disease. There are differences. Patients who need by-pass surgery should know which hospitals and surgical teams give them the best chance of success. The death rate for that key and common heart surgery varies in this country from hospital to hospital by a factor of ten.

Ten. Your chance of dying as the result of by-pass surgery is actually ten times higher if you chose a low-performance hospital. In today's data-free marketplace, consumers who need by-pass surgery don't know where to go to get the best care.

And the worst hospitals have uninformed people innocently choosing them every single day.

Exchanges can be a key forum to improve health care performance.

Consumers should know key information about care-system and care-team performance and should be able to make care choices, provider choices, and health plan choices accordingly.

Data will be key to meaningful choices. It is a very simple and logical truth to realize. Data will not happen on its own. Data will not spontaneously appear. We need to decide as a nation, very soon, what kinds of choices we want consumers to make so we can gather that specific set of data. Do we want to know which care teams do the best job providing quality care? Do we want to know which knee surgeons have the best record of restoring mobility -- or which hip replacement surgeons have the lowest percentage of redo's? Having to do a hip surgery over again is a very life-altering event. Shouldn't we know which surgeons or teams of surgeons have the lowest number of repeat surgeries? Of course we should.

If we want to know that information, we need to set up systems now to track that data -- and we need to build them into the data-gathering agenda for the participants in the exchange.

That data will not appear someday by magic. It also isn't something that we can trigger on a moment's notice.

We need a vision, and we need a plan for the new exchanges -- and we should build those key elements into the macro design of the exchanges now.

Choices are good. Informed choices are better.

Informed choices can't happen without information.

Informed choices also can't happen unless there is an exchange-like mechanism that facilitates choice. We need robust exchange approaches that allow large numbers of people to make meaningful care choices. If the new exchanges are large enough to define and influence the market they serve, the quality improvements that result will spill over to help every aspect of health care in America. They can be catalysts for real change. We don't need every American in the exchanges -- but if the exchanges create real competition that improves care for the people who buy through the exchange -- that improved care for those people will benefit every patient in America. Why? Spillover benefits. Hospitals that reduce their death rate for their exchange patients will not use less safe processes for the rest of their patients. It probably isn't logistically possible. It would definitely be unethical.

So let's design the new exchanges to facilitate the collection of the right information, and let's set them up to allow consumers to make meaningful choices about health plans, health teams and best care.

This really isn't a hard concept when you think about it -- but it will absolutely never happen unless we think about it.

Orbitz for health. Informed choices. Health Care Reform -- Stage Three.

Stage One -- Cover everyone.

Stage Two -- Improve care for chronic care patients.

Stage Three -- Use well designed exchanges to create real choices for consumers and reward the best caregivers.

We need all three stages. When we spend more money on health care than any other country by a factor of two -- we deserve all three stages.