pendent sources, could provide meaningful comparisons and enable fair cost analyses.

Suggesting that neither price transparency nor comparative effectiveness research are sufficient to optimize healthcare resource allocation, G. Scott Gazelle from the Institute for Technology Assessment at Massachusetts General Hospital contextualizes not only the call for more transparency but the value of cost-effectiveness analysis (CEA). He suggests that CEA provides a method for evaluating the health outcomes and costs of healthcare services relative to one another in a standardized manner in order to ensure that resources are spent on the most effective services. Following a discussion of examples of how CEA has influenced policy, he closes with a description of some of the limits to expanding use of CEA today, including the lack of standards, insufficient investments in workforce training, and political barriers.

Paul B. Ginsburg of the Center for Studying Health System Change addresses the issue of transparency by parsing out price transparency from quality transparency. In a system where consumers feel little impact from variations in pricing because of insurance coverage, for instance, Ginsburg states that the impact of price transparency is significantly mitigated, barring fundamental change to the healthcare market. However, he suggests that quality transparency provides a better tool for engaging providers and informing consumer choices. Access to these data in the form of physical access but also in the form of providing information that is easily understood and used by consumers will drive better quality in health care as consumer decisions supply an incentive for better care.

Peter K. Lindenauer from Tufts University School of Medicine concurs that quality transparency, or what he terms performance transparency, holds promise for enhancing the level of care at lower costs. However, Lindenauer highlights the limited research documenting the effects of these efforts. He explains that performance transparency drives improvements in value through one of two pathways: (1) the selection pathway, whereby patients, physicians, and insurers use information about performance to preferentially seek care from higher-quality or lower-cost providers, and (2) the change pathway, whereby the release of performance data catalyzes provider improvement efforts by appealing to the professionalism of physicians and nurses. While much more research needs to take place to quantify the success of such efforts, Lindenauer estimates that $5 billion in annual savings could be realized through the public reporting of hospital readmission, complication, and healthcare-associated infection rates. He additionally suggests that while there is limited evidence for benefits of transparency on hospital outcomes, assigning savings to transparency could be inherently problematic at some level, since reporting initiatives provide the stimulus for changes in care, but do not directly change care itself.



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