The RAND Corporation’s Dash for Health Care Reform

Legislators, policy wonks, and Team Obama need a serious set of online decision-support tools (DSTs) to understand, compare, and evaluate the myriad and conflicting proposals to reform health care. In mid-January, the RAND Corporation entered the fray, busily promoting to the media and legislative staff what it calls a global positioning system to comprehend the effects and unintended consequences of competing reform proposals. Called COMPARE (Comprehensive Assessment of Reform Efforts), this online toolkit (www.RANDCOMPARE.org ) allows health care stakeholders to kick the tires of various policy options before implementation.

RANDCOMPARE is essentially an enhanced business dashboard-a DST to communicate complex information quickly by using maps, charts, and other graphics to show multiple results together (see Effective Health Care Dashboards). For example, it compares how policy options such as individual mandates, employer mandates, purchasing pools, or refundable tax credits would affect aggregate spending, consumer financial risk, the patient’s experience, systemic waste, health coverage, capacity, and operational feasibility.

Elizabeth McGlynn, PhD, Associate Director of RAND Health and COMPARE’s Co-Director, said the tool will help make realistic assessments, based on objective standards and facts, and therefore encourage a full understanding of the immensely complicated benefits and risks of the policy choices ahead. She noted that policy options selected for the dashboard and their underlying assumptions were based on RAND’s 26-member advisory committee, who looked at 25 years of health policy proposals and reviewed relevant literature. When asked about two glaring omissions, innovative health plans stripped of onerous mandates and allowing the selling of plans across state lines, she said, We didn’t include them because we made a decision to launch and will eventually add other policy options over time.

Sreedhar Potarazu, MD, MBA, Chairman and CEO of Vital Spring Technologies, which develops software for corporations and government agencies to manage health care benefits’ costs and quality, contends that approaches such as RANDCOMPARE are likely to fail because of a disconnect between trend-spotting and reality. What’s missing in mandates is that someone has to pay for them, and our data aren’t sophisticated enough to put accurate price tags on medical services, he said. These things always cost more than their estimates because we need three key metrics-price, utilization, and the likelihood of consumers using the resources, he added.

Even though there are truckloads of data, they are scattered and incomplete. To analyze health care reform proposals options correctly, Dr. Potarazu suggests investing in the right IT infrastructure to crunch data for the most common medical conditions and providing patients with the right incentives to consume medical standards, and urges providers to maintain standardized, consistent data sets. Consumer-directed health plans are a good start to accurate pricing because people know how much they have in their accounts to spend, what they’re going to pay, and how good decision-making can improve health and lower costs.