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One BIG step in the right direction…Wisconsin health claims database leading transparency efforts

Posted on by Helen Zak

Wisconsin is known for cheese, the Green Bay Packers, and beautiful Door County. What you may not know is that it is also home to a leading non-profit healthcare collaboration among providers, insurance companies and leaders in the community, government and business: the Wisconsin Health Information Organization (WHIO). Last week, an article about WHIO was published via the Associated Press and appeared throughout the country. http://www.miamiherald.com/2013/08/28/3586841/wis-takes-collaborative-approach.html

The Center is extremely excited about WHIO’s recent coverage and success. John Toussaint, MD, was the initial force in getting WHIO off the ground; Julie Bartels, our EVP of National Health Information, served as its CEO; and WHIO’s founding story is a highlight of our second book, Potent Medicine.

So, why is WHIO turning heads nationally? It focuses on a topic that affects us all — healthcare performance and the job of making it public. WHIO has created one of the most comprehensive publicly-available sources of health claims information available anywhere in the United States. It offers unparalleled information for quality improvement and is capable of producing reports on individual physicians, groups of specialists, and clinics in a way that is:

• Secure: Data de-identifies the patients.

• Fair: A fair method by measuring episodes of care rather than units of service.

• Robust: Includes claims information for 70% of Wisconsin residents.

WHIO’s goal is to use the data to improve the quality, affordability, safety and efficiency of healthcare in the state. Prior to WHIO’s efforts, insurance companies used their own data to create quality and cost analyses for providers, but most knew they needed more robust intel. Each had a limited piece of the total information. For some procedures, they did not have enough data to achieve statistical relevancy and could not make accurate conclusions about provider cost. If they had access to all the administrative claims data in the state, however, the blindfolds would be lifted. It was, and is, a powerful draw.

Why is this important? Wisconsin is ahead of many other states in the nation in this area.  Without good cost and quality data, we can’t improve healthcare. Consumers would have no way to evaluate doctors, hospitals, or health plans and thus, have no real choice. The fully informed patient, who understands the risks, consequences, and costs, can best choose the right treatment option. Once people have full access to data — and understand it — they become better partners in their own healthcare.

Informed patients will push healthcare toward better quality outcomes through competition. Patients need us to fully disclose quality and cost information. They need our unbiased opinions. They need a system that supports and guides them through choices for plans, prices and treatment. And then, they need to make choices and take responsibility. WHIO moves us closer to that ideal state.

If you are intrigued and interested in learning more, we are interested in talking to you. We want to help create additional, similar collaborations that lead to real change in healthcare and real results for the patient. Contact me at the Center at hzak@createvalue.org or 920-659-7500.

To learn more about WHIO, visit www.wisconsinhealthinfo.org.

– Helen Zak, President/COO

ThedaCare Center for Healthcare Value

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