Transparency for All Healthcare Costs and Outcomes

I recently had to find a new primary care physician due to a relocation related to my employment. I wanted to make the choice based on the best available information provided by my insurer. I wanted a provider who not only was geographically convenient but one who served patients similar to my age and family medical history. Most importantly, I wanted to know how patients fared under the care of that provider. What were their outcomes? To my dismay, but not surprise, I could not find any information other than gender and hospital affiliation for physicians in my insurer network. The frustration I felt was reminiscent of a similar dilemma I faced when looking for oncology centers for my mother who was diagnosed with Acute Lymphocytic Leukemia in 2006. I wanted to find out which institution and physician delivered the best outcome for a 70-year-old patient with stroke-induced dementia diagnosed with ALL. Unfortunately, no such information existed to allow me to compare oncology centers, hospitals or physicians regarding outcomes or the financial obligation faced by patients. All of the parties touted their various programs but none of them disclosed what most patients care about: what are my chances of survival if I am treated at your institution and can I afford the care? The only outcomes and cost information readily available to patients and their families were about prescription drugs.

Amidst the recent outcry for more transparency surrounding drug pricing and the value they deliver, what is often overlooked is the vast amount of publicly available information concerning prescription drugs. In addition to the FDA prescribing label data, there are several prominent enterprises such as Micromedex and WebMD, which allow patients and providers to compare data regarding varying drug therapy outcomes or compare biopharmaceutical treatment effectiveness and safety rates with surgery or other types of medical interventions. Moreover, in the past decade, several organizations, like the Patient Centered Outcomes Research Institute, have been established through a combination of public and private funding to compare and contrast biopharmaceuticals. Through these resources, one can find out the effectiveness, safety and outcomes of the medicines, based on a patient’s age, gender and disease progression.

Regarding price and cost for biopharmaceuticals, there are publicly available resources such as the RED BOOK™ Drug References which claims to be the oldest trusted source of drug pricing information in the U.S.” In addition, there are varying organizations, such as schools of pharmacy (including my alma mater, the University of Southern California) that conduct economic impact analyses of various medicines. Finally, patients know exactly what their drug costs are when they visit any local pharmacy. A pharmacist can provide the patient the exact cost related to the prescription, including their out-of-pocket cost requirements.

On the other hand, outcomes and cost data are not so transparent when it comes to other segments of the healthcare system. As these sectors are not competing on outcomes, they instead rely primarily on reputation. Patients have no idea as to how they will fare if they are treated at one institution versus another. All they know is what other patients or physicians convey to them without any concrete data to support the particular view.

However, this has not stopped some insurers, provider institutions and academicians in passing judgment upon biopharmaceuticals. They question prices and outcomes of medicines but are not willing to endure a similar level of scrutiny for their services. In fact, some of them introduce tools for consumers and providers to compare price and value for drugs but have yet to develop similar tools for their services. They also call for government price controls for medicines but not for the services they provide. Never mind that biopharmaceuticals consume only 10 percent of healthcare expenditures in the U.S. or that patients pay more out-of-pocket as a percentage of costs for medicines compared to any other healthcare service. The value of medicines to the healthcare system is not part of their thinking. They ignore the fact that biopharmaceuticals are by far the most cost-beneficial intervention in healthcare. For example, in rare and complex patient care, biopharmaceuticals still consume only a small percentage of healthcare costs, and for the past decade most cancer patients have improved in health outcomes over time in terms of additional days of disability-free life primarily due to biopharmaceuticals.

Transparency empowers patients and providers to make appropriate choices. We ought to know the cost and outcomes related to all types of healthcare interventions up front. We ought to have a system that incentivizes and pays primarily for outcomes to ensure the best use of our resources. However, that standard should not be applied to just one segment of the healthcare system. Insurers, hospitals, providers, academic institutions and biopharmaceutical manufacturers should be transparent about their prices, costs and outcomes for the patients they care for or to whom they provide services. Patients shouldn’t have to depend on anecdote and reputation to make decisions about which medicine or hospital or provider to use. Rather, data needs to be both transparent and available in order for patients to be able to make appropriate choices about their healthcare.

Robert Popovian is the Senior Director of U.S. Government Relations at Pfizer Pharmaceuticals.

Morning Consult