>> well, this is not a medicare ise because a medicare physician, i

guess their very limited and cop strained about what -- constrained about what they can charge, so i guess it's more of a question about private insurance. you want to talk that, lou? >> yeah. the question reflects, again, the desire to have greater and greater transparency in all aspects of health care, including what providers charge. two things. first, even though there's no national requirement, i know at least in massachusetts if there's anyone here from massachusetts, there is a new law that requires exactly what you suggest, which is the posting of prices. so that'll be an interesting experiment to see what impact that has. there may be other states, i'm just not aware of it. we'll hear from the consumer panel after us, i think what consumers want to know is our experience has been what consumers want to know is not what the provider charges so

much as what do i have to pay, which then relates to what is the charge in relationship to the benefit package that i have, the network that i have, and, you know, what does it mean to me -- >> and perhaps even the a whole episode of care. >> exactly. from sort of if i'm choosing option a versus b, that's a care pathway which will have multiple services in it. so it'll be interesting to see. that information is increasingly becoming available, again, in this same transparency theme that we're in. >> yeah. i think the gentleman there had a question. >> thank you. david -- [inaudible] i was wondering about the difference between the raw data you have to pay for and the data that's been released. is it primarily a question of consolidation? so you download less data to answer the same questions? is it primarily hipaa, is it some combination? >> yeah. if you go through the process of entering into a data use

agreement with cms, you -- and you guarantee that you're going to satisfy all of the data security safeguards that they require which are serious, they will send you claims data that has a beneficiary id, that has all of the -- [inaudible] zip code of residence of the beneficiary that has the microlevel service of the cms physician public release only reports combinations of physicians and wpt codes -- cpt codes with 11 or more services provided. obviously, if you buy the micro level data, you can see all the services. but it's a major hurdle, to set up data security systems that are impenetrable and are hipaa compliant. >> and also provides the opportunity to pull together various services from different providers that a beneficiary has

had. >> and you have to promise not to release anything that violates it. >> question back there. >> david -- [inaudible] national associate of acos. if the genie's now out of the bottle, from your perspectives what would be best next relative to cms data release? >> i can -- well, paul ginsburg actually mentioned the physician value-based payment modifier, and i'd be curious how many people know what i'm talking about? some? okay, great, a lot. if i had a wish list, it would be that the raw data and the final output of the physician value-based payment modifier calculations be made available at the physician level. i don't know if that's realistic. but that would be, that would be taking this raw data dump that cms has just made and doing the

analysis that a lot of the other presenters have been talking about. the idea behind the modifier is that medicare's going to be measuring quality and going to be measuring efficiency, including all of the service that the physicians order e not just the ones that they provide themselves. so i think that would be a significant step forward. i doubt it's going to happen. >> bruce? >> well, i think a second cross-section as i mentioned would be very useful, but it would be especially useful if cms could correct their errors in the first release so that when they issue the second, the first release is more accurate and, therefore, you can make better comparisons over time. >> i think a number of us have talked about more comprehensiveness and more linkages of the data. for example, part a and other data sources so that you can have a more comprehensive view either of an attributed population or of more of a 360

view of what a physician is doing for the seniors that he or she is treating. >> yes. actually, if i could add one thing, it would be even more advanced would be grouping data into episodes of care to look at how a physician handles, say, a joint replacement or some other well defined episode of care to really be able to compare them to others. yes. >> i am frank with the brookings institution. my question deals with what this might mean for the health exchanges, particularly for each of your constituency groups, you know, policymakers, researchers and payers, you know, even though this data is only medicare, what mic some interesting future -- what might be some interesting future developments we might see with more cms data releases? >> that's a tough one. i think that only in a general way, i mean, if you can learn

things about there's say drug prescribing patterns that is general utility, then the exchanges might be able to use information of that nature, but since they're not generally treating medicare patients, i think there's a limitation -- >> yeah, i would echo that. we've learned, and we have -- i didn't mention this in my comments, but we have since we provide services to medicare beneficiaries through the benefit advantage program as well as part d, we actually have data ourselves on the meld care population -- medicare population, we originally thought we could find all those data with the data we have from the commercial marketplace so that we'd have larger sample size, but we actually have found that these are different populations. that's pretty obvious. but the commercial population, the working age population is different than the senior population. so when we do quality measurement reporting, for example, we use different

benchmark levels of performance between the medicare and commercial populations. i think that's -- my guess is the same phenomenon would happen in the exchange population because that'll be a different population, and particularly it would be evolving over time. >> thank you. questions? oh, there's one back there. >> hi, rachel -- [inaudible] i work in data policy at the department of health and human services. i had a quick question about last year the office of management and budget released an initiative, and one of the concerns was of the mosaic effect, you start to link different data sets, there's a possibility of releasing personally identifiable information on beneficiaries or on clients, so could you please touch on that? >> i don't have -- >> yeah. so this brings up the elvis'

doctor problem which is if you report physician-level data and don't have a minimum number of procedures or patients treated and if you report on the practice patterns of elvis' doctor and everybody knows who that doctor is, then you can find out everything else about elvis. so that's the motivation for the 11 plus minimum claim requirement. and, you know, i mean, there's obviously a risk that really sophisticated data analysts are going to be able to take this data release and combine it conceivably with other data sources and figure out things about individuals. my guess is that there's probably a big or risk from hackers just getting into the

cms mainframe, but i don't really know. but i think that we're definitely in an area of risks and trade-offs, and there's benefit to these data being made available. there are increased risks, and the more data sources are made available in greater granularity, the more risk there is of people being able to combine things in normal ways and -- in novel ways and kind of undo the privacy protections. i guess as a research i would say let's keep in mind the benefit of these data being made available and not to just go with always the safest approach. >> yeah. i think the principle of the greater good does apply here. and, in fact, even on the data releases there will always be some errors, and there will always be some misinterpretations of the data, and there will always be a physician who's unfairly singled occupant as behaving poorly

when, in fact, that person hasn't. but as has been said, those are the costs, but you have to weigh the benefits, and i think we're the mind that the benefits exceed the costs. certainly, privacy is a risk as well. >> you know, we use our credit cards all the time even though our credit card numbers are for sale, you know, through underworld hacker web sites. so our financial system is constantly balancing the benefits of electronic data exchanges against the risks of, you know, malicious hacker activity, and i think we're, you know, we're gradually groping our way towards a similar kind of balance with health care data. >> well, i think it's time to thank the panel for the really good job they did. [applause] we'll execute the same thing, in this to dr. alice rivlin, senior fellow at the brookings

institution, who will be moderating the final session. >> thank you, paul. [background sounds] [inaudible conversations]

[inaudible conversations] >> okay, are we live now? i think we are. now we're going to shift the focus. we have talked about this data release and several other data releases, and we've talked from the point of view of researchers and health plans and the policy community, but what it's all about is patients and consumers. and so now we are going to shift the focus to the patient, the

consumer, and talk about what they need to know. and i hope we can be a bit more visionary and expansive in this panel because we are where we are, but where do we want to be? and i hope that these three representatives who have worked very hard on behalf of consumers over quite a long time can help us think about what do consumers really need, what do they need it for and how can that data be generated? to help us with this question we have, first, robert krughoff who is the president for the center for the study of services/consumer checkbook. and we have robert rest tush ya who is the executive director of community catalyst, a consumer

advocacy organization, and we have doris peter, director of consumer reports health rating center, part of the organization consumer reports. and i think doris' organization rate lots of things. not just health care. [laughter] that's where you go if you want to know about cars or toasters or plumbers or whatever. [laughter] but now we're talking about health care and a really important aspect of so many people's lives. so we'll start with robert krughoff. tell us a bit about what you think consumers need and what they might need in the future. >> okay. well, i think the -- first of all, i appreciate being here, and i believe our priority

should be to have good raw data readily accessible. if the government can do that, that's an amazing, wonderful achievement. and fortunately, i think the government has recognized this is important, it has made significant progress. i'm very happy about niall's recent appointment and love the principal statement in the press release announcing his appointment citing the government's commitment to frameworks promoting appropriate external access to and use of data whether in aggregate or granular form. that's what i think sdthat's wh. unfortunately, there's still a lot to be -- there are good things that have happened, and there's a lot to be done. i give you examples of the good and the bad that i've seen in the governments making data available over the years and just sort of always gives me some anxiety that things might not go so well the next step

around. in 2006 there was hhs' denial of consumers' checkbooks request that we get physician-identified claims so we could give consumers some information on the amount of experience each physician had with various high risk procedures. and the government, siding with the ama in an appeal after we won in the lower court. that was disappointing. there was cms' interpretation of the aca provision on release of claims data that was much more restrictive than it had to be. the cms rules required anyone who wanted the medicare data in order to do performance measures nationally to have matching non-medicare data in every region. that's an enormous practical obstacle, and it wouldn't have had to be interpreted that way. on the other hand, there was the

great news this past april, the government's release destroyed the physician privacy argument against release. so that was an enormous accomplishment, i think. and then that was followed by cms' quick action to get physician identifiers in the large data files that we and others have been using for years to evaluate hospital death rates and complication rates, getting those identifiers right in there quickly was just exactly what needed to be done. and cms recently created the virtual data center program to make use of those files more financially accessible by allowing them to be used remotely, still more expensive than i wish at $40,000 annually for a single person to use, although cheaper than trying to get those part b files straight up which would be in the, you know, 100,000 or more range and

quite unfortunate to cost that much. but there was some bad news when we were told last summer that this virtual research data center system could not be used to produce quality measures on doctors. couldn't quite figure that one out. and so the door sometimes swings open, sometimes closes, but i think we all need to support those at cms working for openness often in the face of strong provide provider opposition. as i say, i believe the focus should be on making raw data available. i'm not optimistic that the government should be, should be itself the producer and reporter of performance measures. but it should be a supplier of diverse -- a supporter, i should say, of diverse independent researchers to develop performance measurement methods and put those methods in the

public domain where they can be critiqued by researchers, providers, purchasers, consumers. we want the data, and we want the method. but it's fine if the government wants to do its own reports, but we worry such reporting would be too cautious to give consumers simple information that'll make it easy to choose providers that will best meet their personal needs and preferences. difficult to use the compare web site, the real lack of development in information in the physician compare web site give one quite a bit of reason for pessimism on the government doing the reporting. and you contrast that to the creativity of propublica which, you know, finds a way to put these data in a forum that consumers can actually use and to be responsive, different response to you than to you and to be able to find the data. all that stuff i think really private entities probably can do

a better job of than cms can do. so what measures need more emphasis, and what data is needed to support them? for a little disruptive perspective, let me share what we have seen from consumers. we watch the use of our consumers' checkbook web site. of all the many types of service providers we evaluate, the ratings consumers look at most often are ratings of doctors. so i've read in reports people say, well, people don't care -- they don't look at quality ratings, maybe they don't look at them, but they look at them twice as much as they look at plumbers and auto repair shops and about 13 times as much as they look at ratings of hospitals. so that's kind of interesting. we've also done tests of consumer interest in different measures of doctor quality. and by far the greatest interest was in consumer survey ratings of doctors and in results of surveys of doctors asking for their relations of other doctors

for -- their relations of other doctors for care of a loved one. both these kinds were chosen by at least three times as many web site users as ratings based on board certification and training or whether a doctor follows nationally-defined, evidence-based medical guidelines for efficiency of care. so where consumers are starting from may be different from what some of us might have expected. so now here are a few thoughts on possible measures for future expansion, and i'm not going to limit myself, i don't seem to be limiting myself word wise in general, but i'm not going to limit myself to talking about these large data sets which trying to think about anything consumers might possibly find useful. so i think one measure is to expand on whether doctors effectively use electronic medical records.

such information can be collected via the meaningful use program, the doctor use of these things, and its importance needs to be forcefully explained to consumers. this really will matter to you or could matter to you. another opportunity might be to explore with specialty boards whether they can let doctors voluntarily identify themselves as performing, let's say, in the top quarter of other doctors on certain dimensions of the certification process. that's something i've never seen done, but it seems to me it would be interesting particularly because it might actually reveal something about doctors' diagnostic skills. and one of the problems, i think, is almost all of our measures out there, process measures, outcome measures even don't really get to the question of diagnostic skills which are so critical to having the good physician. another opportunity would be more measures of clinical bad

outcomes. in analysis we've done, we've seen at the physician level statistically significant differences in surgical death rates, complication rates, readmission rates. this kind of information needs to be public. and if we had better data, measures might be possible to assess whether a doctor is prescribing too many of some kinds of procedures identified in the choosing wisely initiative. a very important challenge is to report on patient-reported health status and outcomes possibly using promise sf and other similar types of measures. i calculated some of these types of measures which requires assembling better databases, of course. there's a continuing need to push for all-payer databases where it will be understood that the data can be used for provider quality measurement. so, you know, we're talking about, you know, large national

databases like that. that's a great thing. i mean as an all-payer database, i should say. but participation in registries is important in the registry rules allow the data to be used for public reporting on provider performance. registries can collect information that goes well beyond what you're going to find in claims data. it makes sense to find out, i think, whether publicly reporting which physicians participate in appropriate registries and explaining why participation matters could actually put pressure on doctors and providers in general to choose to participate. but the big opportunity is in health information exchange. for performance measurement and various other reasons, that's, you know, that can be the heart of a lot of stuff. so that means we need to push for continuing expansion and standardization of information in electronic health records

including patient-reported information and push providers to share this information in large regional and national databases. a public measure telling which providers are participating in these exchanges might actually create incentives, certainly such participation could be a critical component in any future meaningful use programming, and the government needs to invest haughly in this path -- heavily in this path. think of it as the interstate highway system for health care. it's a major investment, and it really should be a focus. finally, i'll focus, finish on a relatively easy and quick but strangely neglected path, getting a nationwide database of patient experience, survey results on individual doctors. a data base which would also be able to be aggregated to the practice site and group level but starting with the individual

level doctor. why the government has not pushed forward with this is baffling to me. we have a good instrument in our cg caps' survey, this survey on possible variance give good information on how well doctors listen, explain things, keep track of the patient's history, coordinate care, engage the patient in shared decision making. this is important stuff. if the doctor doesn't listen, for example, the doctor can't do a good diagnosis or come up with treatment plans that fit the patient. if the doctor doesn't explain things, well, the patients won't know or be motivated to do their part in care. as one article in the journal of american medical association put it, in a diverse set of studies, effective communication has been linked with better adherence to treatment plans, more appropriate medical decisions and better outcomes. and measurement should be at the individual physician level. dana saf run and others in the journal of internal medicine

showed that the individual physician -- not the practice, nor the group, nor the plan -- accounts for a majority of the variance in the communication aspect of patient experience. so why don't we have survey results at the individual physician level? the explanation we hear is that it's too expensive. to prove this wrong, consumers' checkingbook did a demonstration in four metropolitan areas in collaboration with united -- thank you, lew -- and cigna and local blue's plans. we did a rigorous survey and published results at the individual physician level showing a large number of significant differences among physicians. the demonstration showed that this could all be done at a cost of ant $120 -- of about $120 per physician and still show these really meaningful results. this is much less than has been demonstrated across physicians to report pqrs type data. and that $120 can be cut to about $60 or $40 more year since

it's not necessary to do the survey more than once every two or three years, although physicians can be enable to do the survey more often if they choose. so this is a big, immediate opportunity and one the federal government could easily make happen with a little support, financial support and encouragement. thanks very much. >> thanks, robert. that's a rich list of, a wish list of very interesting things. >> so community catalyst is a national consumer organization focused on giving voice to consumers, particularly low income consumers. we have historically been fighting to open up the black box and have been supportive of robert and consumers' union and propublica's work. i think it's important to look at consumers from two perspectives. one is the role of user and

payer, another in terms of their public policy role. you know, with the trend towards cost sharing and health plans, it's become more important for consumers to be good purchasers. and with the implementation of the aca, millions of people are looking at the exchanges, the marketplaces to choose health plans. so i think we've had a lot of experience with that and, frankly, i think they're still either not looking at that black box, or they're looking at it through the lucite lens. because there's a lot of problems. consumers and unions, consumer and payers even find the most basic information elusive. the urban institute recently came out with a report that it's difficult to get information from many marketplaces about welcome back -- marketplace web

sites about whether a health plan is tiered, what providers are in the network and what are the cost-sharing differences associated with those tiers. for the low income consumers, quality data is complex and very difficult to understand. it's clear that one size doesn't fit all. in fact needs of -- information needs of a 6-year-old dually eligible is very different than the needs of someone coming to checkbook. so in terms of what we're talking about today, i think we need to start with getting the basics right. we need better information about who and what's in a network and what are the costs to consumers. charlie mentioned the importance of accuracy. the data needs to be made more understandable for consumers taking into account the wide range of differences. community catalyst has beenporting an effort to

develop -- supporting an effort to develop a single quality measure that could be broken down into component parts, focusing on the particular needs of consumers. we agree with robert in terms of patient-reported information. we see collecting patient activation as a quality measure and a focus on outcome. and finally in terms of consumers, they need help doing this. you know, the average person is not going to be able to make the kind of cost quality equations that we need in terms of coming up with values without support. medicare beneficiaries get this sort of assistance through the state assistance programs. we have a consumer assistance program as part of people focusing on enrollment. we need to sort of think about expanding that program. so in terms of consumers, in

terms of public policy there's important pieces to really think about. community catalyst was one of the first organizations to push for transparency around the conflicts of interest of pharmaceutical companies and physicians. it was actually the courts that opened that data up. charlie and propublica took that database and made it into a very effective tool for looking at what is the relationship of the pharmaceutical industry to the physicians. that perhaps hasn't helped in terms of allowing the individual consumers to make choices about either their drugs or their providers, but it's had a significant impact on medical schools and hospitals. from a public policy standpoint,

it's made a really important change. the other area that we have been working on is around hospitals and community benefits. hospitals want to keep what their community benefits are often a mystery, and the value of those community benefits a mystery to consumers. community organizations want and need to have that information. we've been working hard to get a database of information around schedule h which provides some of that hospital community benefit data with george washington university. so we're looking to move forward and improving that kind of data for consumers. consumers need to understand on the basics of health care the idea of sort of some of the broader trends in health care are a black box to consumers. the government and consumer

organizations need to push hard for opening up that black box. >> thank you, robert. >> hi, i'm from consumer reports, and i direct the consumer reports health rating center. while we're an arkansas debit user -- ardent user of all the day we've been talking about today, our role is to try to put it in context and raise awareness with the problems of that data, bring to light. so that's really what we focus on. and so it's really about having people use the data, not just having the day available. and by using it -- data available. we are able to identify some of strengths and weak 'ems of that data. -- weaknesses of that data. a group of doctors and consumers and writers who take data from various sources and translate that for consumers, and we look at drugs, preventive services like cancer screeningses, hospital quality, physician quality and also health plan

quality. so we've been doing this more about ten years. we reach about 20 million consumers per month and even more through our partners, so not just through our own media products like consumer reports magazine or online. also through partners that can reach other audiences. you're more probably familiar with our work in the area of cars and electronics. we often compete with those areas, and we make fun of each other. i'd rather be testing cars than hospitals, and we can't bring hospitals into the lab and all that -- [laughter] but, so it's a healthy rivalry. i was just looking up some data the other day, and i was really excited to see that in our own measurement of how our readers use data and understand these stories, that our stories on health care costs and quality whether it's about physicians or about hospitals or about drugs sometimes supersede or rank higher than stories about cars and electronics and washers. so it's really at top of mind for consumers, these areas of

cost and quality. and consumers can understand it and use the information. so that's another common question i get asked is, quell, you know -- well, there's all this data out there, consumers can't really use it. but consumers can use it, and we hear from them about the changes they've made east in the hospital that they've chosen or the drugs that they take or, importantly, the discussions that they have with their providers a. hot of our editorial -- a lot of our editorial content drives discussions about the drugs or the hospital, so it's important to reinforce that relationship. so the thing is, you know, we really appreciate what cms has done in releasing data, and we advocate to continue that release of data. the important thing, though, that i see that's sort of been skipped over is the issue of safety and errors. that's one area that's really hard to measure. and we seem to have jumped from sort of process measures and readmissions all the way to patient-reported measures like

whether you can climb stairs but skip the really difficult task of measuring patient safety and measuring errors. we've actually asked consumers in our own surveys about this. we had about 30% of people self-reported they experienced one or more errors in a hospital. and that's probably a huge underestimate. because that's just what the patient noticed themselves, not so much what went unnoticed to them. so i really feel like not only in the area of data collection, but in the area of how we measure safety and errors that this is a really important thing for us to focus on. another way to get at this issue is through registry data, probably the most powerful day that's -- data that's out there. i think that's an area where we'd like to push more to get that data available to the public. we've been able to be successful in a small area of heart surgery. we've worked with heart surgeons that have voluntarily released their data to the public. we have hospitals and doctors that are really high performing and each ones that are low

performing that have agreed to rereese their data. and i -- release their data. and i think this is the most powerful decision tool consumers can use because they can look at a procedure they may be undergoing and find those hospitals and physicians that perform the highest in these ratings of quality. and those quality measures look both at outcomes and also at complications in a reliable way. so that's what we would ask that we sort of make more public, and i think cms with the power that they have to require these sorts of quality reporting systems, that they start making that more of a requirement in terms of being reimbursed by cms. and then some sort of more tangential requests i'd have is to not try to reinvent the wheel. i think it was brought up that cms is sort of required to do public reporting as well. and it kind of makes a lot of confusion at the level of the consumer because those web sites

that are out there now that the government puts out, hospital compare and things like that, are very difficult for consumers to understand. so i would suggest they focus more on the day and the quality of the data and requirements for reporting the data rather than the consumer side of things. and then the final thing which is kind of a little geeky is i would ask cms not to forget about infrastructure because those of us who use the data have to deal with the structure of the data, the missing elements in the data that make it hard to release accurate and timely reports to the public. so thank you. >> well, we've heard a lot about choosing doctors, we've heard some about choosing health plans. i'd like to ask each of you to say a word about how you would hope the feedback to the providers themselves and to the health plans would improve the situation over time. because isn't that, ultimately, what we hope consumers having

better information will accomplish? any thoughts on that? >> well, we've watched with this patient experience data most carefully and tried to work with some of the specialty societies and stuff to tell doctors how they can improve and where they can find resources to improve. i must say i don't think we've been particularly successful that, but i think that's probably because we're not very good at it. we tend to be a measurement organization, not a quality improvement organization. but, you know, there ought to be potential there. however, i don't think -- and, yes, that is one of the objectives, but i also think that one of the objectives is helping consumers find the good ones. and that also gets you good care. i mean, there are two paths one can go down here. >> yeah. i think that when you look, for example, the pharmaceutical data, i think that you have the

professional societies stepping up and understanding that there are implications to the conflicts of interest in trying to address those who have changing policies within the societies, within medical schools and within academic medical centers. yeah, i think there is, it's necessary to have a partnership hoar. i don't think the market's -- here. i don't think the market's going to move us away from all providers who are, quote-unquote, poor quality of care. >> right. >> that's not going to happen. so we're going to need to rely on a partnership between the hospitals, doctor cans, consumers to really got it right. >> in our public reporting of hospital quality data, we really do see a real big response by hospitals. first, they get angry, of course, because they don't like to be rated, but then they tell us they're focusing on the things we're reporting on. so the more we focus on things we want to change, the more they're going to change. that came in the form of a

complaint. how come you're doing this? my physicians are focusing on what i'm reporting on as opposed -- [laughter] i thought that was successful. thank you, i did my job. [laughter] so that's one area, we also see areas where hospitals will call us and say, thank you. we didn't know xyz, now we're going to look into it and understand why that's a problem. those are the kinds of problems i really like to get because i know the people there really care about it. and we also hear from hospitals about patients canceling surgeries and them losing revenue. so there is some market change going op. it may not be as much as wade like right now, been we'd like right now, but there's something happening. >> both doris and robert krughoff talked about getting the raw data out there, and you were quite vociferous about how government should just get the raw data out there, but there are risks in putting out raw data that haven't really -- the risk of misinterpretation as we

saw in this data release that triggered this event. >> well, i think there is some risk, and there will always be some risk that the data will just be wrong, you know, the way cms has it in the first place -- >> or misinterpreted. >> -- or it will be misinterpreted. you know, i'm always troubled by that response. we've had a lot of experience. we have a health plan comparison tool that we've tried to put out, we put it out in the illinois exchange, for instance, and we asked the federal government can we have the benefit, the description of benefits, the co-payments, you know, co-insurance, etc., for each of these plans so we can do an actuarial estimate for out-of-pocket costs for each plan. the best estimate for someone like you so you can make this comparison in a coherent way that most people don't have a chance of doing. and the government, unlike the

part of cms we're talking about here, the government said, no, we can't -- we're not going to give you those data. and this many they finally said, well, we'll give you the data the day before open enrollment starts. well, you know, these actuarial estimates take many weeks and very complicated calculations to do. we get it the day before open enrollment. but the reason, this were two reasons. one is the plans wouldn't like it, and the other is that we might put out something that's confusing or that is wrong. you know, i believe in the marketplace of ideas, that you put out something that's confusing and wrong and nobody listens to you again and somebody sues you. i hike that way of having the world work -- i like that way of having the world work. and we take some chances on that front as opposed to not giving the information out. >> lest we get too focused on government not releasing, big companies don't like it very much either. >> that's right. [laughter]

>> i think it's time for audience questions. and we have possible microphones. there's one right -- a question back here? >> hi. i'm loren hershey, i was a guest psychological lear here under -- scholar here about the breakup of at&t about 28 years ago, so hi, alice. i follow medicine a little more closely given my aging process, and i'm curious to learn mayor clinic -- mayo clinicking cleveland clinic, there'sal lo patrick medicine -- i never thought it in those therms. that's health care delivery. so my curiosity is to ask each of you three panelists how to you evaluate what's happening, how do you measure it and how do you describe it?

has this wellness movement been around for two years or six years or nine years? i don't want to establish -- i don't want to connect it to some personalities on tv. i want to can connect it to -- i want to connect it to university of michigan where i've read about it or yale university. but the question is data. so if i move 10,000 steps a day, big deal. but it's supposed to make me healthier. how do you measure that? do you get my point? >> um, i think, i think i understand what you're trying to say. that movement's billion around for a long time -- been around for a long time around. we rate diet products and exercise, i think we take it in the form of the preventive services. i think that's one of the areas we focus on in terms of helping people understand what preventive services that can keep them healthier. i'm not sure if that's along the line of what you're thinking of, but that's our focus. that's the aim we take.

>> yeah. i guess i see there's a trend towards payment reform that would move you in the direction, move hospitals and payers in the direction of treating a person more holistically. you know, it's certainly been around for a long time, but i i this it's getting much more traction now. >> but some of it's not medical. >> right, exactly. >> so much of it is not. it's nutrition, it's exercise -- >> exactly. >> and are there evolving systems for evaluating that from the point of view of the consumer? >> well, if you think about the dual demonstration projects, there's -- i think there are evaluations going on now of that, and that's really looking to take the medicare and medicaid payment, combining it and keeping people out of hospital and out of nursing homes and theoretically healthier. you know, that's something that i think the research triangle is doing right now. >> i think there's, i think the

visibility of, you know, patient self-help and nonallopathic medicine has increased over time with tv and a lot of newsletters and things like that. i do think that many of the health plans are looking for alternative ways to help their members, hoping that these will solve problems and reliefs the health plans -- reduce the health plans cost. and some of these providers, i mean, for instance, checkbook does evaluations of acupuncturists. that's for more of a straight up where you don't really know whether the person's hitting the bottom of your foot right. at least some of those things you can get some meaningful feedback on the quality of those providers and at least on the ability of the providers to explain things, and, you know, or to get miracle cures.

i've had a miracle cure by an acupuncturist. after many times he said you have to listen for the che, and then he put a lamp on my leg and put on music and let me sleep for half an hour, and he said how did that work for you? it was terrific. when he had been talking to me, i mean, it was a warm lamp and sleep, i'd been thinking did i lock my bike out front? [laughter] i don't know. people have very different views on how this stuff works. >> [inaudible] [laughter] >> how do you get the -- [inaudible] >> yeah, yeah. >> [inaudible] >> yeah. well, i i think we haven't done much, in general that has not been -- it's a bigger and bigger part of the system and the economy, and i don't see it as having the same level of visibility and measurability that we're trying to see in the

regular medical care system. >> other questions? >> i have a question that comes from twitter. is there any information about increasing consumer engagement through transparent cost and quality data, and how can we increase engagement? >> i can speak anecdotally. just from our organization to, we definitely see an increase in engagement from consumers in both the data we're providing and also with their stories and consumers telling their stories to us. i think what can make it more useful is making the data more accessible, more personalize bl and making it more about their day-to-day decisions, decisions they're making about procedures such asthma alternativety, child -- as maternity, childbirth, knee replacement, things like that. >> there's been literature about why consumers get involved or don't get involved in cost and

quality data. i think for low income consumers it's somewhat different and need to think about, you know, how to engage folks who have historically maybe been not insured. that's where we think consumer assistance is important. the medicare program has assistance in people choosing plans. we think that's something that would sort of really help. >> yes. >> thank you -- [inaudible] i know there are some providers and organizations that are in the business specifically to help people, and there are others that are in the business to make money. and i'm just wondering from your analyses, can you differentiate one from the other? [inaudible conversations] [laughter] >> well, i don't think we can get to their, to the heart of their motivation, but i think we

can, we can look at their performance. and we can see are they, in fact, making people better and are they keeping costs reasonable, are they overprescribing? so i do think it's possible. even some of those things, i talked about this choosing wisely type, you know, assessment which is, obviously, very important thing. and we don't know how to do that. i mean, and we're going to need better data to really decide, you know, start rating -- identifying providers who are really abusing as opposed to just getting a whole lot of referrals for somebody who actually needs that treatment v. before we wind up, let me ask each of you very quickly if you look ahead ten years, what would you like to see in this world of consumer information about health care and consumer choice?

what are the most important things that you think the world ought to look like ten years from now in this dimension? starting with doris. >> i'll go back to where i was before with safety and medical errors. we've been trying to crack that nut for at least ten years if not more. so if in ten years we're able to have a way for consumers to understand medical errors within any particular hospital or surgeon, that would be where i would want to be. >> and there are fewer risky providers. >> yeah. >> i think we need to consolidate information, make it easier for the consumer to use. i think we need to focus more on outcomes in the patient experience. >> yeah. i would agree that we have to push toward measuring outcomes. you know, different people are in very different situations. somebody who has no chronic condition and who has no acute condition is not much interested in outcomes except they want to

avoid having something go wrong. somebody who has a, you know, a serious chronic condition really is looking at measures that are very clinically oriented, etc. and so those things have to be tailored, as you say, to -- the measures have to be tailored to the patients or to the consumers. >> given the demographics, more and more people will have -- [laughter] >> up the ladder, right. >> thank you very much, all of you. this has been a very good panel, and i hope that some of these things come to pass quite soon. let me turn it back to, well, yes, a round of applause for the panel. [applause] [inaudible conversations] >> and then let me turn it back to kavita for some final remarks. >> all right. thank you, alice. this won't take very long. i just wanted to thank all our panelists again and also our excellent staff at brookings.

a number of people who helped make sure that everybody's, everybody was as comfortable as possible and also for the folks watching on the web. i just want to highlight a couple of things. i mentioned some of the work we're already doing with this data set and data releases. weaver going to have several -- we're going to have several more briefs that talk about topics covered today, and i wanted to be a little provocative in what might be coming after today's conversation. we've talked about kind of uses that are not just consumer-centric, but what happens if some of this data could be used to create some of these high value networks that we're seeing in the private marketplace as well as on these health insurance exchanges. and what if we could actually, as chapin alluded to, get researchers together and almost do kind of a crowd sourcing of valuable research cases or findings, things that we all find interesting that we don't necessarily have one entity taking lead responsibility for, but that we could work with

nonprofits, research organizations as well as consumers on what they find interesting and try to put that together in a way that's not contingent on what the government would do. and then finally i think doris kind of talked about a conversation that's been missing around safety and errors. it wasn't that long ago that we had crossing the quality chasm and some of the work of don berwick and colleagues who highlighted these problems. inunless we'd be remiss to think we'd solved all of them, how can we be pointing towards places to improve and think about concentrating efforts from transparency and data to show people not just what's bad, but what we can do to improve the infrastructure of health care in our country. so i did want to point that the conversation won't end today. we are going to be doing future publications as well as hopefully extending this in other ways. so thank you for your time and attention, and have a great rest of the afternoon. take care.

[applause] [inaudible conversations] >> friends and colleagues of former d.c. mayor marion berry will attend a memorial service today being hld at the washington, d.c. convention center. several government officials and civil rights leaders are expected to attend including reverend jesse jackson who will be delivering the eulogy. we'll have that live today beginning at 11 a.m. eastern on c-span. >> the c-span cities tour takes

booktv and american history the on the road traveling to u.s. cities. this weekend we partnered with time warner cable for a visit to waco, texas. >> as we began to receive the vinyl to be digitized, to be saved, we began turning over the b sides of the 45s that we received. now, first off, gospel music was not widelyhead heard in the -- widely heard in the white community. but the flip side would be heard even less. and what we discovered quickly was how many of the b side songs were directly related to the civil rights movement. since there was very few databases and none of them were complete on all gospel music, we didn't know that. we didn't know the sheer number of songs that had very overt songs like there ain't no segregation in heaven type songs. at a time when possessing one of those songs, much less singing it, was a very dangerous thing in the deep south. you could get away with a lot of

things in the deep south, but singing that sort of song, well, that's a risk. >> the texas ranger hall of fame was set up in 1976 for the 175th anniversary of the rangers and honors, at this point, 30 rangers who have made major contributions to the service or gave their lives under heroic circumstances. we have paintings or portraits of all those rangers. they really begin with steven f. austin. austin was very successful with his rangers. they fought not only, managed to make the area reasonably safe for settlement from indian raids, but when the texas war for independence broke out, the rangers played a may yore role in texas -- major role in texas gaining its independence by staving off the mexican army long enough to allow the colonists to build their own army and develop a strategy. and as a result, texas became its own independent nation, the

republic of texas, for about ten years. >> watch all of our events from waco today at noon eastern on c-span2's booktv and sunday afternoon at two on american history tv on c-span3. >> you're watching booktv on c-span2, with top nonfiction books and authors every weekend. booktv, television for serious readers. ..