Airlines
Airlines are a pretty good case of what works - and what does not - where transparency and quality are concerned.
The Airline Quality Rating. Operational since 1991, this rating system uses objective data to track airline quality along multiple dimensions. All data are deemed relevant to consumers and come from elements are derived from the Air Travel Consumer Report maintained by the U.S. Department of Transportation. The ratings represent weighted averages of performance aspects deemed relevevant to consumers and includ on‑time arrival, mishandled baggage, involuntary denied boardings, and 12 customer complaint areas. All elements are originally obtained from those reported in the Air Travel Consumer Report maintained by the U.S. Department of Transportation.
AirlineQuality.com. A comprehensive site featuring qualty and pricing information derived from independent reports, industry surveys, and consumer contributions. Includes chat rooms and other venues to discuss flight preferences.
Amadeus.com. This site was mentioned in the "Practical Traveler" section of the New York Times on May 20, 2007. In this Times article (subscription required), Michael Higgins discussed airlines who employ extremely complex pricing schemes both for seat preference, times, upgrade miles, meals, and snacks. Amadeus makes such complexity possible. In a press release of January 15, Amadeus states that "implementing Amadeus Dynamic Availability in conjunction with Amadeus Married Segment Control, TACA is able to accurately identify the most valuable bookings based on origin and destination (O&D) information whilst protecting itself against O&D misuse. Consequently, TACA can ensure connecting flights are linked together in bookings, preventing partial cancellations of the higher yield long-haul segment after availability has been granted on the short-haul route." Questions? :-)
FareCast.com. A "know when to buy" site, labels itself as the "first airline prediction web site." It offers membership acounts and offers airfare predictions from over 75 U.S. departure cities to top U.S. destinations. It differentiates itself from traditional sites by offering advice on when, and where to buy. It uses mathematical formulas to predit rates with a self-desscribed 74.5% accuracy. It gives both tips, savings for waiting, and a confidence measure. The chair of their technology advisory board is Professor Oren Etzioni - a legend. Other members share similar technical credentials. The firm has strong, entrepreneurial venture capital behind it. Watch this site to push the limits.
Flyspy.com is the work of Robert Metcalf. He describes his site as a "consumer-centric airfare search engine that offers travellers:
- high market transparency and high customer confidence
- at-a-glance view of the market
- multiple search & decision-making options
- dramatic reduction in search time
- no trial-and-error searching
It differs from Expedia, Orbitz, and Travelocity by displaying all travel options for the next 30 days in a visual format. Flyspy helps the consumer understand the marketplace for airfares. When the traveler has flexible travel dates, flyspy is great at finding low-cost fares." His graphical interfaces are remarkable. This is an example of how consumers can learn and exploit profit maximization and pricing schemes.
Google's fairly comprehensive airline travel site. Includes a photo gallery of airline meals for those who want to diet. The photos of meals are contributed by passengers are are near "real time." Perhaps hospitalized patients should begin the same process? hmmm....
Kayak.com. This site was created by founders of a number of leading travel sites. It derives its revenue from click results (like Google and Yahoo). It includes the ability to search automatically across multiple sites, compare fares, explore pricing trends, and discuss issues with other Kaya.com members. It emphasizes fares.
Seatguru.com is a proxy for quality. It provides detailed information on airline seating comfort, ammenities, and other travel information. Want to know which seats have power outlets for your laptop? Seatguru claims to know. Founded by frequent flyer Matthew DAimler, the project was launched in 2001 and incnoporated in 2003. It had its first full-time employee in 2004. Some data are prorivded by "SeatGuru" staff and others are contributed by flyers, pilots, flight attendance, and other airline staff. It is, in essence, a communal rating system. It was ranked one of the top 12 Travel Websties in 2006 by Forbed Magazine. Could patients, health care professionals, and staff do the same thing for health care organizations? Why not?
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Quality
A Checkup on Health Care Markets (RWJ, Powers and Painter) Your Guide
to Choosing Quality Health Care (AHRQ). A comprehensive (some would say encylopedic) 44-page document that includes definitions, advice on choosing health plans, hospitals, and doctors, and some advice on maintaining personal health information.
Are Consumers Influenced by Quality Metrics?
Center for Health System Change. Davis, Hibbard, and Milstein. Consumer Tolerance for Inaccuracy in Physician Performance Reporting Ratings. One
size does not fit all. Health plans increasingly use physician performance ratings,
but some physicians are concerned that measurement inaccuracies may jeopardize their reputations and livelihoods. Absent from the debate thus far are consumer views about how accurate physician ratings need to be for various uses. Consumer tolerance for inaccuracy in physician performance ratings varies widely, according to a new national study by the Center for Studying Health System Change (HSC). At least one-third of adults have a low tolerance for inaccuracy (5 percent or less), but more than one of every five adults would tolerate ratings that were 20 percent-50 percent inaccurate. Consumers’ relatively higher tolerance for inaccuracy when used for public reporting and tiered networks may speed these uses of physician performance ratings by health plans. However, consumers’ lower tolerance for inaccurate ratings when choosing their own physicians and paying physicians for performance may hinder such uses.
The Predictive Accuracy of the New York State Coronary Artery Bypass Surgery Report-card system. Jha and Epstein. Health Affairs 25, no 3 (2006); 844-855. Abstract: We examined the impact of New York State’s public reporting system for coronary artery bypass surgery fifteen years after its launch. We found that users who picked a top-performing hospital or surgeon from the latest available report had approximately half the chance of dying as did those who picked a hospital or surgeon from the bottom quartile. Nevertheless, performance was not associated with a subsequent change in market share. Surgeons with the highest mortality rates were much more likely than other surgeons to retire or leave practice after the release of each report card
Public Reporting and Pay for Performance in Hospital Quality Improvement. Lindenauer. NEJM 356 (February 1, 2006); 486-496. Conclusions Hospitals engaged in both public reporting and pay for performance achieved modestly greater improvements in quality than did hospitals engaged only in public reporting. Additional research is required to determine whether different incentives would stimulate more improvement and whether the benefits of these programs outweigh their costs.
What Happens to Prescription-Drug Use After Consumer-Directed Health Plan Enrollment? Fairman et. al (Express Scripts). Summary.CDHPs produce considerable savings, both in total drug cost and net-payer cost. These savings are achieved by 1) payment of a greater proportion of cost by the enrollee and 2) reduction in brand use, which is only partially offset by increases in generic use. The chronic-medication-persistency differences observed in the first quarter of the year had mitigated, but not disappeared altogether, by the third quarter. This finding suggests that members may have anticipated the change to CDHP and stockpiled medication prior to the end of 2005, making early (first-quarter) estimates of CDHP impact somewhat misleading. .....Finally, they curtailed medication use instead of consistently substituting generic
for brand medications.
Are providers influenced by quality and performance metrics?
Pay for Performance at the Tipping Point. Epstein. NEJM 356:515-517
(February 1, 2007).
Consumer-Directed Health Care And The Courts: Let The Buyer (And Seller) Beware. Jacobson and Tunick. Health Affairs, 26 (3),:704-714 (2007). Abstract:
In consumer-directed health care, patients will be expected to exert greater control over their spending decisions than before. As consumer-directed care gains market acceptance, courts will inevitably be involved in resolving challenges to the new arrangements. We anticipate that courts will be generally favorable toward consumer-directed care, but the new legal doctrine will not uniformly favor medical professionals and insurers. The information demands inherent in consumer-directed care will present particular legal challenges to physicians and insurers. Even as courts provide flexibility to reflect the new market realities...
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Price
National and International Trends in Health Care Financing and Delivery
The Uninsured: A Primer (Kaiser Commission
on Medicaid and the Uninsured, 2006).
Consumer-Driven Health Care: Lessons From Switzerland. Herzlinger and Parsa-Parsi. JAMA 292 (10): 1213-1220 (September 8, 2004). Abstract: Switzerland's consumer-driven health care system achieves universal insurance and high quality of care at significantly lower costs than the employer-based US system and without the constrained resources that can characterize government-controlled systems. Unlike other systems in which the choice and most of the funding for health insurance is provided by third parties, such as employers and governments, in the Swiss system, individuals are required to purchase their own health insurance. The positive results achieved by the Swiss system may be attributed to its consumer control, price transparency of the insurance plans, risk adjustment of insurers, and solidarity. However, the constraints the Swiss system places on hospitals and physicians and the paucity of provider quality information may unduly limit its impact. The Swiss health care system holds important lessons, including evidence about its feasibility and equity, for the United States, which is now embarking on its own consumer-driven health care system.
The Swiss Health System: Regulated Competition Without Managed Care. Reinhardt. JAMA 292 (10): 1227-1231 (September 8, 2004).
From "Soak the Rich" to "Soak the Poor": Recent Trends in Hospital Pricing. Anderson. Health Affairs 26 (3): 780-789, 2007. Abstract: In 2004, the rates charged to many uninsured and other "self-pay" patients for hospital services were often 2.5 times what most health insurers actually paid and more than three times
the hospital's Medicare-allowable costs. The gaps between rates charged to self-pay patients and those charged to other payers are much wider than they were in the mid-1980s, and they make it increasingly more difficult for some patients, especially the uninsured, to pay their hospital bills. This has triggered lawsuits and some recent government efforts involving price transparency. Three specific policy options that could lower the markups are a voluntary effort by hospitals, litigation, and legislation.
Follow the Pill: Understanding the U.S. Commercial Pharmaceutical Supply Chain. Health Strategies Consultancy for the Kaiser Family Foundation (March, 2005). An outstanding review of the nuances of drug pricing.
AHRQ Information Collection Activity (Federal Register Vol 72, no. 88, May 8, 2007, p 26117) This Comment request deals with "Chartering Value Exchanges for Value-Driven Healthcare." This project proposes to twice annually post a public call for parties interested in becoming chartered as Value Exchanges for Value-driven Healthcare. Anticipated benefits of being a chartered Value Exchange include (1) participation in an AHRQmanaged Learning Network and (2) eligibility to request Medicare-inclusive multi-payer patient de-identified individual physician-level performance measurement results. To be eligible, interested parties must first be recognized by HHS Secretary Michael O. Leavitt as a Community Leader for Value-driven Healthcare. Follow this link for additional information on Community Leader recognition.
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General Issues on Transparency and Quality
Federal and State Government
State Comparison Sites (Pharmaceutical)
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