Alliances have had mixed success in the two areas of cost—publicly reporting cost and reducing the cost of care. Almost half of the Alliances were able to report resource use, charge, price, or cost on at least three procedures or conditions. While some Alliances were able to provide this data publicly, others focused on sharing this information privately with particular stakeholder groups. Overall, Alliances were more successful in their attempts to reduce health care costs—the majority of Alliances have reduced the cost of health care in their market. The level of success varies, but many Alliances lowered costs by reducing hospital admissions or readmissions.
It is important to acknowledge the link between cost reduction and payment reform. As Alliances work to reduce costs, there must be an understanding of where the cost savings would accrue. Additionally, although it is critical to tackle quality and cost simultaneously, many of the high-cost specialties lack robust quality measures. Contributing to the development of specialty quality measures was not a focus for most Alliances—they concentrated on primary care—but work done to develop this area will support efforts to reduce costs.
A number of markets are engaged in discussions at the community level and in some legislative bodies around the development of all-payer claims databases (APCDs).APCDs can be a great source of price information for consumers, as they contain data on what was actually paid for all services and procedures from a number of different payers. Markets without an APCD may have access only to provider pricing, which does not represent total costs for the service or procedure and thus is less useful to consumers. Whether these efforts to develop ACPDs will help or hinder the work of the Alliances remains unclear.
As a result of the national attention to reduce health care costs, a number of organizations have launched efforts to acquire data or work directly with stakeholders who have access to data. A number of groups focus their work on providing consumers and employers with products and services to manage health care spending and employee care. For example, Healthcare Bluebook is a health care marketplace through which consumers can get care from providers based on price information for health care products and services. Castlight Health is another example; it provides services designed to enable employers to evaluate their benefit structure and empower employees to make informed health care decisions by understanding the value of services offered. While efforts by these and other organizations may raise awareness of the importance of using of cost and quality data, they may also result in competitionwiththe efforts of regional health care improvement collaboratives that are using more comprehensive, multi-stakeholder approaches to collecting, analyzing, and publicly reporting cost data. Whether these otherentities create healthy competition, an opportunity for partnership, or competition with Alliances is unclear.