Information Needs Associated with the Changing Organization and Delivery of Health Care: Summary of Perceptions, Activities, Key Gaps, and Priorities. Assessing Emerging Issues and Needs

04/30/1997

Our respondents provided insights into the kinds of questions that they cannot address well with existing information. We summarize very briefly below this topic, addressed and described more fully in the report.

Health Care Structure. Most current information on the structure of the health care system is oriented toward the counting of the individual types of resources (like providers, facilities, or health plans) that make up the structure. In contrast, our project showed that there is a need for much better information that can be used to assess the adequacy of these resources, changes in them, and the relationships of these resources both to one another and to the existing financing system. For example, who is buying and selling medical practices? What is the right benchmark for medical staffing? What are the characteristics of health plans in different markets? In addition, there is a perception that much more information is needed to support assessing medical practice and training needs, particularly for physicians which tend to account for most existing resources. For example, how many physicians do we really need? Concerns also are widespread over limitations in information on the financing for the health care system and the absence of data on employers. The latter are viewed as increasingly active in driving marketplace change and influencing public policy outcomes.

Operational Process and Performance of Health Care Providers and Plans. There are three types of needs here. The first is a need for better knowledge of the structure of and responsibility for the process of care given the growth of managed care and integrated systems in an increasingly competitive marketplace. For example, who is actually providing the care, how does a patient reach a provider and what incentives influence the care a provider considers? The second is a need for information to support understanding how structural relationships, like the transfer of risk or growth of technology, influence the process of care. For example, do physicians actually know and understand the contractual provisions that influence their pay? The third is for information that provide insight on the relative efficiency of individual providers or health plans in an increasingly competitive marketplace. For example, what really are the differences in cost or performance between teaching hospitals and others?

Outcomes of Care Delivery. This kind of information has been the least developed historically and is viewed as increasingly valued by those concerned both with assessing the value of care and with understanding its costs and distributional implications. One key issue is how to interpret information on practice when there are no benchmarks or standards for practice. For example, is a caesarian section rate that falls or is below average too high or too low? Simply having outcome information, particularly on a risk-adjusted basis that can be compared across providers or plans, is a problem. Costs as outcome measures, are a second key issue, with current data providing limited insight on the costs of achieving given outcomes or on how capitation or ambulatory care delivery each influence cost. A third key issue is how to interpret current population-based information on access and distribution (like insurance coverage or uncompensated care) in today’s market-place. For example, if uncompensated care drops, is this a positive sign that more individuals are insured/able to pay for their own health care or does it mean providers are less willing to see the uninsured?

Cross-Cutting Issues and Needs. Across structure, process, and outcome measures, there are concerns that information needed to address issues at the state and local level are also lacking and that existing data systems have some inherent weaknesses that undercut the utility of information. These include weaknesses in the clinical components of information systems, inconsistencies in data derived from plans built around diverse models, and inconsistencies in the data available centrally about managed care plans regulated differently across insurance systems or states.

Summary List of Key Data Gaps. Table S.1 summarizes the key data gaps that limit the ability of stakeholders to answer the questions they need to answer in today’s market. In terms of structure, there is limited and incomplete information on insurance and health plans, as well as on ambulatory and community providers. The limited information on insurance/health plans is a particularly large problem because it complicates the already challenging need to generate better information about how providers in the health care system are linked to one another and with health plans. Getting better information on various facets of these systems was a key need perceived across a variety of stakeholders.

The absence of standardized transaction level data with appropriate clinical content that can be flexibly analyzed and linked to cost and outcomes is a key data gap that serves as a barrier in addressing many of the questions stakeholders have about the process of care and outcomes of the health system.

TABLE S.1

SUMMARY OF DATA GAPS IDENTIFIED FROM THE PERSPECTIVE OF
STAKEHOLDERS OUTSIDE THE FEDERAL GOVERNMENT

STRUCTURE

Component Parts of the Health Care System

  • No comprehensive census of health insurance plans or arrangements exists
  • Limited information available on community based alternatives to long term care, intermediate models
  • Data on ambulatory care and non-physician providers is limited, incomplete, and inconsistent.

Linkages among Parts of the System

  • Little information on ownership and/or aggregation of physicians and/or hospitals
  • Integration and arrangements (including transfer of risk) between health plans and provider entities and their constituent individual providers not identifiable in data.
  • Linkages across the continuum of care not identifiable in data.
  • Duplication exists across diverse data collection efforts

PROCESS AND OUTCOMES

  • Transaction level information on services which can be linked to individuals, providers, or health plans are often absent
  • Clinically relevant data are limited.
  • Need the ability to link expenditure data to functional role rather than setting
  • More meaningfully categorized expenditure data are needed including out of pocket spending and spending for given outcomes or people

CROSS-CUTTING CONCERNS: GEOGRAPHICAL RELEVANCE AND STRATEGIC FLEXIBILITY

  • State specific data are often lacking for all or some states. Data for policy relevant localities (e.g. inner city) is even more limited
  • Data need to be adjustable for residence versus service location (especially when areas cross states)
  • Data need to support consistent trend analysis but data captured need to be flexibly defined and timely to account for change in the health system
  • Data should permit flexible aggregation at different levels (e.g. service level; provider level; patient level; or population level)
  • Data need to be capable of being linked to relevant population-based units to support targeted analysis (e.g., individual with a given health problem).

SOURCE: MPR Analysis

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