Peter A. Wadsworth, Stephen M. Shortell, John S. Toussaint
(Health Affairs Forefront 7/19/22)
In this article, we describe the rationale and design criteria for a public-private approach to improving the quality and value of health care in the United States: a Publicly Reported Health Outcomes (PRHO) program. This long-term, aspirational initiative, focused on results and transparency, will require both public- and private-sector action.
Rationale
The US currently lags behind most Organization for Economic Cooperation and Development (OECD) countries in life expectancy, infant and maternal mortality, and many other measures of mortality and morbidity. While many factors contribute to this quality gap, huge variations in health plan and hospital mortality rates suggest that US health outcomes could be substantially improved. In fact, recent research demonstrates that hospital mortality rates can vary by a factor of 3 to 1 and health plans by 4 to 1, and publicly available quality ratings of health care plans and services do not correlate well with outcomes. What is more, lack of transparency among health plans and provider organizations prevents purchasers from making informed choices based on relative quality of provider organizations and health plan networks. Currently available outcomes data are limited to Medicare fee-for-service.