Inside Information

State and local governments mold a new relationship with constituents, helping them become better and smarter consumers.

by / June 1, 2006
Over the past few years, the public sector spent considerable time and money making myriad transactions available to the public via the Internet.

People appreciate the convenience, and they appreciate "their" government responding to their wants. The public sector is slowly changing people's perception by creating an image of government agencies that care about their customers and want to nurture the relationship.

Some governments now use the Web to provide information to help citizens become smarter consumers. Public agencies have long collected price and performance data from a wide range of industries, but rarely made it available in a user-friendly form for average citizens. Agencies at all governmental levels are beginning to offer online services that help customers make better decisions on everything from gasoline purchases and investing to choosing hospitals and schools.

That's new ground. In the past, information tended to flow one way: from citizens and businesses to government. Society gained because the data was used to ensure compliance with environmental, safety and fairness laws, as well as other regulations. But many citizens felt little direct benefit from this activity.

Nowadays, some governments are doing more to help people as they go about their lives, doing the seemingly million and one things they must accomplish on any given day.

Comparing Hospitals
Florida's Legislature passed the Affordable Health Care for Floridians Act in 2004. The bill directed state government to implement a consumer-focused, transparent health-care delivery system in the state. The bill also stipulated that the state create a mechanism to publicly report health-care performance measures and distribute consumer health-care information.

Florida's Agency for Health Care Administration (AHCA) is revamping its Web presence to report and distribute health-care data to consumers. One expanded site,, delivers health-care data collected by the AHCA's State Center for Health Statistics to consumers.

The site is designed to make it easy for health-care consumers, purchasers and professionals to access information on quality, pricing and performance. One such tool is Florida Compare Care, which was launched in November 2005.

Through the Compare CareWeb site, Florida now reveals data on infections, deaths, complications and prices for each of its 207 hospitals. Residents can use the site to compare short-term-care hospitals and outpatient medical centers in various categories, such as length of stay, mortality, complications and infections.

The Web site lists hospitals' rates of medical problems in seven categories, and provides patient death rates in 10 areas, including heart attacks, strokes and pneumonia.

When the AHCA started devising Florida Compare Care, the agency turned to the Comprehensive Health Information System (CHIS) Advisory Council for help. The council and various CHIS technical workgroups, which include hospital representatives and various other stakeholders, were involved in the Web site's development from the very beginning, said Toby Philpot, the AHCA's deputy press secretary.

"The workgroups have studied the technical issues of reporting performance data, as well as discussed the most appropriate options for reporting and displaying the information on the Web site," Philpot said.

Creating a Web site such as Florida Compare Care is dicey because of the complex nature of the information being presented, he said.

"Because of their expertise, some hospitals treat more high-risk patients," Philpot explained. "Some patients arrive at hospitals sicker than others, and often, sicker patients are transferred to specialty hospitals. That makes comparing hospitals for patients with the same condition but different health status difficult."

To get the most accurate data on the Web site, he said, each hospital's data is risk adjusted to reflect the score the hospital would have if it provided services to the average mix of sick, complicated patients.

The risk adjustment is performed by 3M Corp.'s All Patient Refined-Diagnosis Related Groups.

"This adjustment should allow comparisons between facilities that reflect the differences in care delivered, rather than the differences in the patients," Philpot said.

New Attitude
State Rep. Frank Farkas, a chiropractor, said he sponsored the Affordable Health Care for Floridians Act, in part, to help health-care consumers.

"High on the list was transparency -- and transparency in a couple of forms," Farkas said. "One was being able to shop price comparisons for pharmaceutical drugs. The second part was hospital outcomes for mortality and infection rates. This is all information that our department had that was being given to them by the pharmacies and hospitals, but nothing was ever done with it."

The most difficult part of creating the Florida Compare Care Web site was creating consumer-friendly information out of federal reporting data, Farkas said, explaining that such standards didn't hit the level of detail needed for Florida's new Web site.

He cited infection rate data as a prime example because it was difficult for the AHCA to determine whether patients came in with infections prior to admission or developed infections while in the hospital.

"The way it's measured right now, it just shows an infection rate for the hospital, but it doesn't break it out."

The federal government, which was redesigning a form hospitals use to report data to states, added a new data entry point to extrapolate infection rate information, he said.

Interestingly enough, collecting the information didn't create much of a hardship for the AHCA, which had been gathering medical data all along.

"The information was required, yet the AHCA was never required to do anything with it," Farkas said. "It was basically information that I'd say was useless because you're requiring hospitals to provide it, but it was just reams of paper sitting in a room."

Beyond Individuals
The Florida Hospital Association (FHA) supports the creation of Florida Compare Care, as well as other transparency issues in health care, because of the state's approach, said Rich Rasmussen, the FHA's vice president of strategic communications.

"What Florida tried to do was include everybody in this transparency effort, so that we'd have transparency on the pharmaceutical side, the hospital side, the health plan side and the physician side," Rasmussen said.

Though the Florida Compare Care site helps individual consumers, Rasmussen said the benefits extend to wider audiences, such as employers, health planners, health plans, insurance companies, hospitals and the FHA itself.

"We purchase that data and we customize it for our members," he said. "If you're trying to do strategic planning and want to look at, for example, the health disparities in the community, we can do that. If you wanted to find out how many heart procedures were performed in a certain ZIP code, we can give you that. All of that information is very helpful when you're doing that planning."

Employers can make excellent use of this information too. The transparency effort enjoyed strong support from the business community, Rasmussen said, because companies view the data as a valuable tool for large purchasers of health-care services.

The next phases of the project will incorporate similar information on health plans and physicians to the FloridaHealthStat site, he added.

"Most employers don't shop hospitals; most consumers don't shop hospitals," Rasmussen said. "But they shop health plans. So having good information out there will help consumers and employers know what the out-of-pocket [costs] will be for their employees, what the co-payments and deductibles are going to be, what the exclusions are going to be, what performance measures are used by health plans.

"As we roll more of this information out, consumers -- and I lump into that group purchasers, such as businesses -- will have a better idea of the total continuum of services they're buying."

Market Driven
Florida's new approach to providing health-care data came about because of the trend toward consumer-directed health care, explained Farkas.

"We're seeing a huge increase in the amount of health savings accounts being sold nationwide," Farkas said. "People are using their own money. We want to make sure they're getting information to make good decisions. It's interesting health care is the only industry that you've not been able to price shop or even quality shop.

"You've never been able to really see how safe a hospital is compared to other hospitals; which doctors had the best outcomes; how much they charge for elective procedures -- those are things you're going to start seeing on this Web page."

This is part of a larger movement in which the public sector is enabling constituents to choose service providers, said Bill Eggers, global director for Deloitte Research, Public Sector, and a senior fellow at the Manhattan Institute for Policy Research.

"Yet to have choice, you need good information about price, quality and performance, and that was typically not available for many public services, whether it was education, social services or health care," Eggers said. "Choice became very, very difficult to implement well in practice."

The Internet, of course, makes it much simpler for the public sector to take the complex information it stores, package that data and present it in a way that helps consumers.

At the federal level, Eggers said, the U.S. Securities and Exchange Commission (SEC) embarked on an effort to give better informational tools to investors and analysts.

"The SEC is putting together a lot of technology initiatives to change the way public companies, mutual funds and so forth disclose financial data," Eggers said.

In early March 2006, the SEC announced it would hold a series of roundtables throughout 2006 at its headquarters in Washington, D.C., to discuss the best way to hasten implementation of these new Internet tools.

The roundtables also will review first-year results of a pilot that has been using interactive data from company filings with the SEC to let Internet users search and use individual data from financial reports, such as net income, executive compensation or mutual fund expenses. Currently financial information is generally presented in the form of entire pages of data that can't easily be separated by people reviewing the data from PCs.

The rationale for the SEC's initiative is that if investors have better information to make choices, the market will be improved because companies and mutual funds will have to improve performance to attract investor attention.

"It's yet another example of something where you had a marketplace and a lot of information," Eggers said. "But now the SEC, which was holding a lot of different information, has the ability to improve the marketplace by putting the information online and nudging some of the mutual funds and companies to do so also."

Street Cred
Local governments also collect a wealth of information that can help constituents make the most of their buying decisions.

Nearly five years ago, Westchester County, N.Y., posted a gasoline price database on the Department of Consumer Protection's Web site, said John Gaccione, the department's deputy director.

"The department always conducted a gasoline price survey -- it was a random sample -- and then we would release an average price," Gaccione said, noting that the county executive and the director of the Department of Consumer Protection wanted to modernize the existing process by putting the survey information online.

"It [the site] also allows us to give trends in prices or show stations in a particular area or ZIP code so that a consumer is empowered with information and can make better choices, or choices that better fit their needs," Gaccione said.

The department surveys 400 gas stations bi-monthly and informs consumers on which stations have the best prices. The online database also provides information about specials, such as "cents off" days, and stations that offer diesel fuel.

Gaccione said people told the department they appreciate the service, recalling that some feedback indicated consumers were surprised by the database's availability.

"It gave them access to information they didn't even know existed," he said, explaining the constituents' surprise. "Second, it allowed them instant access to that information. There are people, traveling salesmen, that if they know they can go to a certain place and gas up their car and save 10 cents a gallon, that's something they're going to rely on in the course of their everyday life or business."

It's something people want from the public sector, he said.

"You can get a sense that there's a growing expectation of, 'If government is collecting this data and it can help the average person, get it out there.'"
Shane Peterson Associate Editor