Editor's Corner

This week, Michael Leavitt announced plans to establish "value-based" health quality exchanges nationwide. The idea, which is admirable in principle, is to get healthcare players in a given region together--including unions and employers--and pool quality data in a usable way.

But isn't it a bit soon to take this step? After all, the concept of "value" purchasing in healthcare, while a useful construct, is still very much in flux. For example, some thinkers have proposed that providers compete by quoting fees for treating an entire condition. Other health analysts would like to see providers paid based on how well they adhere to appropriate medical practices, or how good their outcomes are. Reporting requirements would differ dramatically depending on which model you choose.

This is where Leavitt's proposal starts to look problematic. If we're still having a national debate on something as fundamental as what as unit of healthcare "value" actually is, pushing providers into highly public quality reporting measures may not make a lot of sense. After all, without a consensus on healthcare value--one which feels right to consumers, insurers, employers and providers--the data won't get enough use to justify the effort.

There's little doubt that some sort of uniform quality reporting--based on a better-developed idea of "value"--will be in place at some point. In the mean time, though, if such programs just force healthcare providers to meet yet another data requirement, we haven't gotten anywhere. - Anne

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