The Hartford Courant

September 10, 2006
By John W. Rowe, M.D., Retired Aetna Chairman

One of the most important themes in health care today is consumerism - people having more choice and control over how to spend their health care dollars. But more choice and control come at a price. Increasingly, employers are giving their employees more skin in the game by asking them to pick up a larger share of the cost of their health insurance, with the expectation that such cost-sharing will reduce use of unneeded or discretionary medical services. And some new health plans, called consumer-directed health plans, are designed to give people more choices about how their health care dollars are used.

But giving employees more financial responsibility will not, by itself, be sufficient to cause people to make better decisions regarding their use of health care services. The key to making consumerism and consumer-directed health plans work is to give people information they need, on cost and quality, so they can make better decisions about their own care. This concept is known as transparency, because the opaque inner workings of the health care system are made much more transparent.

This concept has been much in the news since President Bush recently signed an executive order on transparency, which focuses on the right solutions: value-based competition in health care, the use of information technology standards, the need for quality standards developed by the medical community, the sharing of data on the price of care, and the creation of incentives to measure and promote overall quality in care.

We all do research and comparison-shop before buying a car or a house, even when deciding where we go on vacation. Doesn't it make sense to be equally engaged in the process of choosing health care - deciding what doctor to see, what hospital to go to or what treatment options to select? If it costs more, is it necessarily better? People can't be empowered to make more prudent health care decisions if they don't have the information they need readily and clearly available.

Part of the problem has been that, until recently, it's been challenging for the average American to access information on health care price and quality for their individual health care providers.

In a nation with some of the greatest medical technology, treatments and clinicians, that important piece of the equation has been missing, and it's needed now more than ever - from private insurers such as Aetna and government programs such as Medicare.

The cost and utilization of care continues to outpace other parts of our economy. Evidence-based clinical guidelines still aren't followed much of the time. And there continue to be wide variations in health care utilization, outcomes and status based on factors such as geography and race and ethnicity.

Regarding transparency, Aetna broke new ground a year ago when we gave members in the Cincinnati area access to the prices we negotiated with their doctors.

It was very well-received by employees, patients and policy-makers because it opened up a black box in the industry. Our intent wasn't to encourage members to choose doctors based solely on price - and we doubted many people would do that anyway - but to be clear about what Aetna was paying the physicians who treated our members. Members could see what they would be charged before they went to the doctor - an obvious consideration in any other area of commerce, but a novel concept in health care.

Based on our early success and additional input from the medical community, Aetna has recently introduced the next phase of transparency.

Aetna members in Connecticut and 10 other states, plus the District of Columbia, now have online access to physician-specific cost, clinical quality and efficiency information. Although the price information is Aetna-specific, the quality and efficiency measures are based on standards developed and widely recognized by the medical community.

This initiative is getting national attention and is an important advance in our industry because it gives members a solid foundation for purchasing health care based on overall expected value, not just price.

Health plans have a responsibility to do more than just pay health claims for people. They need to give them the information they need to make the best possible choices that allow them to receive high-quality, cost-effective care.