Outline
A health plan brings transparency to the quality and price of the health care system. This paper presents the summary, major themes of the article ‘A Health Plan Work in Progress: hospital-physician Price and Quality Transparency’. Along with its learning outcome, the relevance of this article in the health care system of the US and sharing with colleagues about some of the perspectives on this article are also briefed in this paper. There are some challenges and risks in the implementation of this health plan. This plan will help bring transparency of quality and price to the health care system.
Introduction
The epitome of the article ‘A Health Plan Work in Progress: Hospital-Physician Price and Quality Transparency’ is briefed here. This article is about the consumerism strategy of health plans that emphasize the ramp-up of price and quality transparency efforts. Concerning the enormous interest of the employers in this plan, there is an attempt to develop a consumer tool to assess the price and quality information in the hospitals.
When the health plan becomes a strategy of consumerism the employee will be more responsible for the medical expenses, lifestyle choices and the decision on the treatment. The main points which are discussed in the article are the ramp-up of price and quality transparency efforts in health plans, applying consumerism strategy in health plans perceiving the idea that competition motivates health plan efforts, price transparency which makes price information on physicians and hospitals available through websites, transparency of the quality of the hospital and physicians, challenges and risks due to introduction of the transparency of quality and price and the implication of this health plan emphasizing on the transparency of price and quality of the hospitals and physicians.
With the introduction of the ‘facilitated consumerism strategy’, there began an issue of increasing the costs of care. This led people to search for high-quality health care spending at the lowest cost. By introducing the transparency of price and quality, the people themselves can determine the physicians and hospitals concerning the efficiency and quality of care, spending lowest cost. Consumerism strategy of health plan brings competitions between different health maintenance organizations. Health plan creates new value for care by making health cost and quality transparent and it was embraced by many national insurers, it is open to assessing the quality and cost of the care.
At the same time, there are risks and challenges for this health plan. The biggest challenge in the implementation of the plan is the possibility of misinterpretation and wrong information on the price and quality of the care by consumers. Then, the next risk is that the question of who has access to it. The information on price and quality are given on the website but many people do not use the website for health care. Every program will be undergone through a sheer evaluation, but this health plan does not have an efficient evaluation format. Health providers are indifferent towards this and the negative responses from physicians are also reported.
The federal government is reluctant to publish the data of Medicare physicians’ claims that would inform the private insurers on the performance of the physician. The federal government should bring this health plan under a common measurement of transparency of the quality and price by participating in private and public partnerships of insurance providers, employers and various stakeholders who have contact with this health plan.
Major themes in this article
Facilitated consumerism and health plan strategy
A health plan will enhance in bringing the transparency of quality and price in the health care system. Health care had been embracing facilitated consumerism and there was no transparency in the quality and price of health care. Through a health care plan, the consumer will decide the treatment, price and quality. “Plans generally provide some type of price information on inpatient and outpatient procedures and services from data based on their own negotiated prices or through aggregated health plan claims data obtained through a vendor; few plans provide price information on services in physician offices.” (Tynan, Liebhaber, & Ginsburg, 2008, para.2).
The strategy of consumerism
“Many health plan respondents, particularly those representing large national insurers, reported embracing consumerism, including price and quality transparency, as a way for health plans to create new value for their employer clients.” (Tynan, Liebhaber, & Ginsburg, 2008, Consumerism strategy, competition motivate health plan efforts, para.2). There is competition among various health providing organizations relating to giving quality care. When the health plan works the various health maintenance organizations will attempt to give quality care at the lowest cost.
Price transparency
“Several national health plans and a regional plan reported providing some type of price information based on their data—usually negotiated prices with hospitals and physicians—and are making this information available to enrollees in specific geographic areas on a rolling basis.” (Tynan, Liebhaber, & Ginsburg, 2008, Price transparency, para.1). National health plans make the various hospitals provide information on the price of the care. When the information is published through the website the consumer will have the access to assess from which hospital, he can receive quality care at the lowest cost.
“Few health plans reported providing price information for physician services; when they do, they generally provide the average cost of physician office visits in a particular geographic area, sometimes by city or zip code, and these costs are not specific to particular physicians.” (Tynan, Liebhaber, & Ginsburg, 2008, Price transparency, para.8). At the same time, there is a possibility of misinformation regarding various data on the hospital and physician. Some of the responses from the consumers support it.
Quality transparency
“Most of the quality information plans are providing pertains to hospitals rather than physicians. This reflects both the greater availability of third-party hospital data, as well as more widely accepted quality measures for inpatient care that are collected and reported by organizations independent of health plans, which mitigates concerns by providers and others that health plans might provide information biased in favour of health plans’ interests.” (Tynan, Liebhaber, & Ginsburg, 2008, Quality transparency, para.2). Through the transparency of quality, the consumer can know the facilities and the performance of the hospital and physicians.
Learning outcome
In the 1990s there was an increase in the health care cost which led to the notion of ‘facilitated consumerism’. This results in shopping for high-quality care at a low cost. Health became a source of inequalities. The more money one spends on health the more he gets cured. When there is no public awareness about the expenses of the care, there is a possibility of a timely rise of the cost of care. Therefore, a health plan will certainly help to reduce the cost of care and to increase the quality of care. Moreover, it will bring competition between different health maintenance organizations that would result in the high quality of health care with a minimum cost of care.
If there is transparency for quality and price, the people can assess the quality of care where the price is too low. But the major challenges concerning this health plan are that there is no proper evaluation method or format. The consumer does not know how to assess the program, and therefore, he is not able to give adequate suggestions for better implementation of the program. All the information regarding the quality and price will be published on the websites. But many people do not visit websites for better healthcare.
So, it will be an obstacle in the implementation of this health plan. Most health maintenance organizations may not be opened to publishing accurate data on the quality and price of care. Physicians may be reluctant to give correct information on their performance. All these factors will be barriers to the execution of this plan. But what I assume is that it will bring a change in the health care sector in the coming years. If there is healthy competition between health providers, there is no doubt about receiving high-quality low price health care. Since the US health care system is entirely operated by the private sector, this health plan will help provide transparency in the quality and price of care.
US health care system and the article
“The focus on price and quality transparency gained momentum when President Bush issued an executive order in August 2006 directing federal agencies that administer health care programs to share price and quality information with enrollees.” (Tynan, Liebhaber, & Ginsburg, 2008, Health plans ramp up price and quality transparency efforts, para.2).US health care system is entirely operated, and health insurance is given by the private sector. Therefore, the health plan has a vital role in providing high quality and low-price care. So, the department of health and human services incorporated a notion that highlights ‘high quality and low-price care’ as the centre point of health care improvement.
Sharing with a colleague
The transparency of quality and price in the health care system is necessary today. So, the implementation of a health plan will help to increase the transparency of the health care system. By the health plan, the consumer will be able to know more about various health care systems and their services. The consumer demands the quality of care where the price is low. Therefore, it will aid the consumer to assess the various health organizations in terms of their quality and price. Moreover, the consumer can know about the performance of the physicians. It will certainly lead to the transparency of quality and price of health care and thereby the quality of health.
But there are some difficulties in the execution of this health plan. Even though there are attempts to mould a measurement to assess the health plan, there is no proper and adequate tool for measuring the accurate evaluation of health plan. The information regarding the transparency of quality and price of care is published on the websites. But many people do not use websites to assess the health care system.
So, in the initial days, the health plan will have many barriers to overcome. There are reports about the negative responses from the physician regarding their performance. This plan will motivate the health maintenance organizations to bring more quality in the health care and low price. If there is healthy competition between health providing organizations, indeed it will result in high quality in the health care system.
Conclusion
A health plan is a strategy to bring transparency to the quality and price of the health care system. This paper is an epitome of an article about health plans discussing various dimensions of a health plan. The main points discussed in it are transparency of quality and price of the health care system and some of the risks and challenges in the implementation of health pan.
Reference List
Tynan, A., Liebhaber, A., & Ginsburg, P B. (2008). A health plan work in progress: Hospital- physician price and quality transparency. Centre for Studying: Health Change System. Web.
Tynan, A., Liebhaber, A., & Ginsburg, P B. (2008). A health plan work in progress: Hospital- physician price and quality transparency: Consumerism strategy, competition motivate health plan efforts. Centre for Studying: Health Change System. Web.
Tynan, A., Liebhaber, A., & Ginsburg, P B. (2008). A health plan work in progress: Hospital- physician price and quality transparency: Price transparency. Centre for Studying: Health Change System. Web.
Tynan, A., Liebhaber, A., & Ginsburg, P B. (2008). A health plan work in progress: Hospital- physician price and quality transparency: Quality transparency. Centre for Studying: Health Change System. Web.
Tynan, A., Liebhaber, A., & Ginsburg, P B. (2008). A health plan work in progress: Hospital- physician price and quality transparency: Health plans ramp up price and quality transparency efforts. Centre for Studying: Health Change System. Web.