Measurement (and Transparency) Drives Behavior

This issue, we welcome our first guest contributor, Glen Hall, who writes on how to answer the key questions to help sort out the wheat from the chaff amid the deluge of new healthcare products and services. Meanwhile, our own Fred Crans offers Part II of his benchmarking series.

As I read their articles, I got to thinking about how these tenets will change as we proceed down the reform path. After all, a significant portion of the Affordable Care Act (ACA) uses measurement and transparency as the devices to motivate desired changes in behavior. Much more has been written about how effective measurement is in driving behavior change. And we are all motivated daily by the use of transparency in driving our behavior (e.g., which gas station we pull into is typically motivated by the transparency in the price per gallon). Sadly, to date, these motivators have been severely underdeveloped in the healthcare supply chain.

Glen writes about getting customers to define value. To date, price has been the defining value articulated by supply chain practitioners. Tomorrow, as motivated by the ACA (and ultimately and rightly, by the patients we serve) value will necessarily be redefined. Products and services that reduce readmissions, improve quality and support the medical home concept will be of higher value than lower-cost alternatives.

By now, you may be rolling your eyes, thinking “C’mon, Captain Obvious, those criteria are already part of our value analysis process.” But are they really? We do the best that we can today by gathering available evidence, but defining value requires the ability to articulate specifications, or at least an expected outcome against some measurement. This is where I believe we have a long way to go. The corollary to Measurement Drives Behavior is You Can’t Manage What You Don’t Measure. How many hospitals have the means to measure the impact of a specific product or service on readmission rates or quality? How many of us even have the ability to know what products were used on a specific patient? I’ve been working on this problem for most of my career and know all too well the challenges, but as a future patient, I want to know that these types of measures are being put in place (ACA or not).

Fred’s benchmarking series brings to mind the degree to which we must go to find publicly available comparative information. Price transparency has been quashed by the use and acceptance of confidentiality clauses in purchase agreements. I am not an attorney, but would it be breaking confidentiality if we simply tallied the existence of such clauses? What if, as a way to begin motivating a higher level of price transparency, we published a simple count of the number of agreements with and without price confidentiality clauses, by supplier, GPO and provider? Might we pull into a different “station” given that information?

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