Patient information database could help reduce waste, provide best care
By: Health Insurance
Submitted: 2009-11-20 10:27:47 | Word Count: 615
Care for heart failure is relatively cheap in Madison, but treatment for severe arthritis is expensive.
Doctors in Dane County give more women mammograms than elsewhere in the state but test fewer heart patients for cholesterol.
[ advertisement ]
Those are among the findings from a major new database of patient information formed by insurers, employers and health-care providers in Wisconsin.
The database, which reveals how the cost of care, adherence to proper screening and other factors vary by region and doctor group, will encourage physicians to reduce waste and give patients the best care, organizers say.
"We'll be able to find out who is performing most efficiently," said Julie Bartels, executive director of the Wisconsin Health Information Organization, or WHIO, which announced the first version of its massive database Thursday.
The project, under development for four years, will allow employers and eventually consumers to choose doctors with the best scores, Bartels said. It should also help Wisconsin prepare for federal health-care reform legislation, expected to include incentives for physicians who follow certain measures.
"Improving the value of health care is the only way we're going to be able to reform the health-care system," Bartels said.
Most of the information isn't available to the public, but more of it might be in coming years.
Whether doctors prescribe certain drugs or keep patients in the hospital another day can be influenced by many factors, including how they were trained, what drug company representatives they encounter and how many nurses they work with, said Dr. Tim Bartholow, a senior vice president of the Wisconsin Medical Society, which is part of WHIO.
The "pressure of transparency" from the database will force doctors to standardize their care, Bartholow said.
The effort focuses on "episodes" of care. Those include all doctor and hospital care, drugs, therapy visits, lab tests and other expenses stemming from a single medical event or for a year.
Information from 1.6 million patients in Wisconsin is in the database. The number is expected to double next year, largely from the addition of patients on Medicaid, the state-federal health plan for the poor. Patient identities are withheld, Bartels said.
Organizers have only begun to study why medical costs vary by region and doctor group.
Patients with heart failure -- a heart that doesn't pump properly -- cost $2,782 a year in Madison. That is 44 percent less than the expected cost of $4,238, which is based on how ill the patients are.
In Milwaukee, heart failure patients cost $5,860 a year, compared to an expected cost of $5,489.
Madison doctors might treat the patients more in their offices instead of in the hospital, though that remains unproven, Bartholow said.
Madison's relatively high cost of care for severe arthritis -- which frequently includes surgery -- may stem from longer hospitalizations or the use of expensive joint replacement devices, Bartholow said.
WHIO members include: Anthem Blue Cross and Blue Shield of Wisconsin; Greater Milwaukee Business Foundation on Health; Humana; The Alliance; United Healthcare of Wisconsin; WEA Insurance Trust; WPS Health Insurance; Group Health Cooperative of South Central Wisconsin; Gundersen Lutheran Health Plan; MercyCare Insurance Co.; Security Health Plan; Health Tradition Health Plan; Dean Health System; Wisconsin Collaborative for Healthcare Quality; Wisconsin Medical Society; Wisconsin Hospital Association; Wisconsin Department of Employee Trust Funds; and Wisconsin Department of Health Services.
