Sunday, April 01, 2012

Free Our Data and Improve Public Health!

This op-ed ran in the current issue of the Boston Business Journal:

By Paul F. Levy and W. David Stephenson

Massachusetts has a stunning opportunity to break open many of the mysteries surrounding delivery of health care.  Doing so will help resolve important public policy issues.  It will help contain rising health care expenses.  And, it will even help save lives and improve the public health.

Doing this requires no new state law.  The law is already on the books.  It requires no addition to the state budget.  The costs have already been incurred.
What could cause so dramatic an impact?  Liberating data that is already in the hands of the state government.

In 2010, the Legislature and Governor Patrick enacted a bill, Chapter 288, that requires the collection of an “all payer claims database” by the Division of Health Care Finance and Policy.  As the name suggests, this database contains every health care transaction between insurers and providers in the state.  The numbers and patterns in this database explain more about our existing health care delivery system than has ever been assembled in one place.

A previous DHCFP commissioner asserted that the dataset would “allow a broad understanding of health care spending and utilization across organizations, population demographics, and geography.” And yet all that value remains trapped and hidden from view, burdened by unreasonable regulations regarding access.

Massachusetts universities and NGOs have the largest collection of health care researchers in the world.  It is time to make this database open and free of charge to those researchers.  Let them create hypotheses and test them — using real numbers.  Allow insurance companies and hospital systems, too, to view treatment patterns and finances to evaluate new policies and models of clinical care.  All this can be done safely and appropriately, because the law contains strict privacy safeguards.

If our leaders have the courage and vision, our state government can set a national standard for transparency in health care.  Let’s be really creative about this.  Imagine how the following idea would be noticed around the world:  Open up the data and announce a state-sponsored conference one year hence, at which researchers are invited to present papers and studies and conclusions reached from the use of this database.  Post those papers and studies on the Internet for all to see, informing public discourse and  generating yet additional hypotheses for further research.

The law, “to promote cost containment, transparency and efficiency in the provision of quality health insurance,” is a good one, but only if the data is really liberated. It must be automatically available to those who need it, when and where they need it, in forms they can use, and with freedom to use as they choose, while simultaneously protecting security and privacy.

Transparency’s societal value is that it allows hospitals and doctors, insurers and the government, to hold themselves accountable to the standard of care we say we believe in — providing the kind of care to everyone that we would want for members of our own family.

Among the other states — Kansas, Maine, Maryland, Minnesota, New Hampshire, Oregon, Tennessee, Utah, and Vermont — that have created similar data bases, we know of none that have taken this approach to freeing the numbers to enable the information to be used for the greater good.  Instead, most states have a governing board or advisory committee that administers or provides recommendations on the reports to be generated from the databases.  That kind of government is a hold-over from the centralized control of another era, a form of government that inconsistent with a world of web 3.0.

Six years ago, Massachusetts began a great experiment in providing universal access to health care.  That has worked well and has now been adopted as a model for the country.  But important issues remain to be decided.  Liberation and transparency can combine to take the foresight and creativity of the Massachusetts health care experiment to the next level, again setting an example for the entire nation.

Paul F. Levy, former CEO of Beth Israel-Deaconess Medical Center, is the author of Goal Play! Leadership lessons from the soccer field. W. David Stephenson of Stephenson Strategies (Medfield) is author of Data Dynamite: How liberating information will transform our world.


Josh Archambault said...

Amen Paul & David!

John Freedman said...

You make excellent points. Two states actually prohibit any release of their APCD data to anyone outside the state agency - which not only guarantees that the data won't be widely used, but also - for all practical purposes - means that the data are unlikely to be fully reliable. This is because only by using data do you get to find its flaws and fix them.

One state you didn't mention is Colorado. Colorado's Center for Improving Value in Health Care (CIVHC) is the APCD administrator. Under the CO statute establishing the APCD, its data must be made available to researchers, providers, payers, employers and others with an interest in CO health. Perhaps that is a model to be emulated.