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Collaborative Health Care Dashboard Adopted in San Francisco

The City of San Francisco has engineered a collaborative, cooperative program to compare health insurance plans offered to city workers and retirees.

Working with Mercer consultants and vendors Kaiser Permanente, Blue Shield of California, PacifiCare and Uniprise, the San Francisco Health Service System’s Dashboard Project will “allow us to collect truly comparable, standardized data so we get greater transparency,” said Bart Duncan, director of the city’s Health Service System.

“We’ll be in a much better position to see ongoing financial performance as well as utilization,” Duncan said.

Originally, a dashboard was a screen in front of a vehicle to deflect dirt, water, mud and snow. As vehicles evolved, “dashboard” came to mean the array of dials and gauges that kept track of the vehicle’s workings.

Enter the next permutation of the word: A 21st century IT dashboard is a computer-driven interface that gathers, organizes and presents information in an easy-to-read, digestible form. Data is often displayed in graphical format, presenting a series of charts and gauges similar to a 20th-century dashboard.

In health care, one of the most common uses of dashboard technology is for comparison — comparing clinical results of treatments, comparing hospital performance, and comparing health plan offerings.

In the competitive world of health insurance, data for dashboard comparisons isusually delivered in a vacuum: Companies A, B and C provide information on their terms, in their language and whoever is receiving the information has to make sense of it.

Gillian Printon, principal with Mercer consulting, said San Francisco’s dashboard is “one of many steps we’re seeing using technology to drive change in health care. The ability to aggregate, organize and display this data is what makes the system work.”

First of Its Kind in California

Scott Heldfond, president of the San Francisco Health Service Board, said San Francisco’s dashboard is the first of its kind in California.

“To the best of my knowledge we are the first public sector employer in California to create this game-changing methodology,” Heldfond said.

“The incredible amount of time and hard work on all stakeholders’ parts has given San Francisco a cutting edge set of tools to use in managing our employee health care costs. We will no longer simply be asking our providers for information during the rates and benefits process. Instead, we will have the dashboard data and therefore can be proactive and negotiate more effectively,” Heldfond said.

Duncan believes the collaborative approach will be the dashboard norm in the future.

“We’re moving from the traditional information-in-a-silo approach, where all this data is poured into one container and it stays there and you have to compare container to container, even though the data in one silo may not have been put in in the same way as it was in another silo,” Duncan said.

“Now, through collaboration and technology, we’re able to make sure the data that’s coming in is all on the same wavelength and it’s all going into one central place for comparison. It’s a more integrated approach,” Duncan said.

Distinctions Get ‘Blurrier and Blurrier’

Duncan said one of the motivating factors in designing the new dashboard was growing confusion among the 100,000 San Francisco employees and retirees.

“The lines between HMO and PPO and point of service were getting blurrier and blurrier,” Duncan said. “We heard from our HSS members that they wanted more to go on. And they wanted to make sure they were comparing apples to apples, something we weren’t sure we were doing previously.”

During past rates and benefits negotiations with the city, health care vendors “operated in many ways in a world based on their own data,” Duncan said.

When comparative data was unavailable, a health plan could demand a 10% rate increase based on mostly anecdotal evidence, city officials said.

“We had no visibility into many of the details,” Duncan said. “There was no opportunity to work with the vendors on an equally informed basis and improve plan design or identify areas where we could hold down costs in relation to other segments of our population.

“The dashboard will make the city and HSS employee members, retired and active, become more savvy consumers of health care services. It allows us to engage our employee members and our vendors in collaborating on real solutions.”

Collaboration, Clear Goals Were Key

Mercer’s Printon said two of the keys to success for the San Francisco dashboard were the city’s ability to get all players to agree and establishing clear goals.

“HSS laid out very clearly what was expected and they were very persuasive in getting the vendors to participate,” Printon said.

Angela Kohls, sales manager for strategic accounts at Kaiser-Permanente, said the city’s ability to get all the players willingly involved was “phenomenal.”

“I’ve worked for Kaiser for more than 20 years and I’ve never seen anything like this. The technology is different, the way data is used is different but I think the biggest difference is the level of cooperation,” Kohls said.

“Mercer and Bart (Duncan) set up an atmosphere of collaboration and mutual benefit. Every carrier had an open attitude,” Kohls said.

The competitive atmosphere is still there, Kohls said, “but there’s also this willingness to share information. And that goes both ways. We also see a lot of information from other carriers which can help spur the competitive feelings.”

“There are lots of other dashboards out there but I don’t know of any like this,” Kohls said.

Statewide Dashboard Also in the Works

The intent behind San Francisco’s dashboard is similar to the goals behind a statewide effort making its way through the Legislature.

Incoming Senate Leader Darrell Steinberg (D-Sacramento) wants to establish a sort of statewide health plan dashboard. His bill (SB 1522) would create five categories of health plans in California, giving consumers a greater opportunity for comparison shopping. The goal, similar to San Francisco’s dashboard, is to give consumers a better chance to make apples-to-apples comparisons before deciding on a plan.

Already approved by the Senate, the bill passed the Assembly Health Committee in June and will now be heard on the Assembly floor.

The bill would require health insurers to fit each of their products into one of five categories developed jointly by two state agencies — the Department of Managed Health Care and the Department of Insurance. The categories would range from “comprehensive” to “catastrophic” and be determined by a range of criteria, including price, access to care and covered services.

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