At the Intersection of Health, Health Care and Policy Cite this article as: Alan R. Weil How Valuable Is Information? Health Affairs, 34, no.3 (2015):366 doi: 10.1377/hlthaff.2015.0139

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from the editor-in-chief

DOI: 10.1377/hlthaff.2015.0139

How Valuable Is Information? by alan r. weil


he call for “transparency” in health care comes from all directions and seems to apply to nearly everything: prices, quality, costs, financial arrangements, and more. The entrenched opacity of the system—embodied in nondisclosure agreements, hospital chargemasters, and proprietary physician rating systems, among others—cries out for sunshine. But where do we start? Collecting, validating, and reporting information consumes time, energy, and money, all of which could be spent elsewhere. Users must invest their own time to understand, accept, and act upon the information that is supposed to benefit them. This variety issue includes a number of papers that help us understand the benefits—and limitations—of information as the solution to health system problems. information for consumers Consumers are the most promising and the most heterogeneous of possible users of information. Matthew Austin and colleagues compared four national hospital rating systems designed for use by consumers. Each rating system has different objectives, defines good performance differently, and takes a different approach to adjusting hospital scores for the underlying risk of the patients whom they serve. The cacophony of ratings that emerge from these various approaches led the authors to conclude that the ratings are “likely to cause confusion instead of driving patients and purchasers to higher-quality, safer care.” Aaron Kesselheim and coauthors reviewed studies that examine how


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consumers respond to mandatory disclaimers on dietary supplements. They found that consumers mostly either are unaware of the existence of the disclaimers or attach little importance to them. information for the health system Much of the current investment in health information is designed to help those within the health care system make better decisions. Yet even these presumably more sophisticated users face barriers to optimal information use. Lainie Rutkow and colleagues surveyed primary care physicians on their attitudes about and experiences with state prescription drug monitoring programs. Despite high levels of awareness and favorable views of their effectiveness, physicians’ use of these programs was inconsistent. Ultimately, the goal of better information is to support better outcomes: higher quality or lower costs. Twothirds of hospitals and half of physician practices now participate in some form of health information exchange. Nonetheless, Saurabh Rahurkar and coauthors’ review of the literature revealed few studies that can link health information exchange to benefits including more appropriate use of services, more coordinated care, or lower patient costs. These studies remind us that there is a long distance between a general call for information and transparency and the positive results that information is supposed to generate. Everyone in the information chain must value the creation, analysis, and use of information in order for the investment in data systems to pay off.

paying for value Another mantra repeated at every health care conference is the need to “pay for value, not volume.” A few papers in this issue add to our growing understanding of the opportunities, and challenges, associated with this seemingly noncontroversial proposition. Sophie Coronini-Cronberg and colleagues chronicle the effects of large National Health Service (NHS) budget cuts on low-value procedures in England and identify potential lessons and opportunities for the US system. Their findings of a significant decline in half of the procedures tracked suggest that “even modest reductions in such lowvalue procedures could represent significant absolute savings” in the United States. The Bundled Payments for Care Improvement initiative is a key element of the Medicare program’s overall strategy to move from fee-for-service toward value-based payments for hospital care. Thomas Tsai and coauthors took an early look at how hospitals are responding to these new incentives. They found that participating hospitals generally enroll in the initiative for a small number of conditions representing high volume and average costs. While this may be a rational response from the perspective of the hospitals, it suggests that the results of the initiative will be difficult to generalize to other hospitals and other conditions. the us supreme court As we go to press, the US Supreme Court is preparing to hear arguments in King v. Burwell, which challenges the availability of premium subsidies provided to people obtaining coverage through the federal insurance exchange or Marketplace. Tim Jost, a professor of law and one of the most-read contributors to Health Affairs Blog, previews the arguments in a case that, if the challengers are successful, will have a dramatic effect on the implementation of the Affordable Care Act. n


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