Medical care cost vs. quality

It's not always easy figuring out whether your health care is worth what you or your insurer pay for it. That's because key information that you'd need to make that judgment—like how well doctors do at treating or preventing disease, how satisfied patients are, and how much it all costs—usually isn't available.

That's not the case in Minnesota, where two nonprofit organizations, HealthPartners and MN Community Measurement, have independently collected that information and agreed to share some of it with Consumer Reports as part of a joint project to rate primary-care physician groups in the state.

The data show that you don't have to pay the highest prices to get the best quality care. And some more-expensive practices in fact don't deliver on quality.

The chart below lists 18 primary-care doctor groups in the Minneapolis and St. Paul area that participate in HealthPartners' network. That organization provides health insurance as well as physician and hospital care, all overseen by a 15-member board made up mostly of consumers. HealthPartners is doing two things that are unique among insurers. First, it's not only assessing quality of care, patient satisfaction, and affordability among its providers but also making the information and the methodology used to arrive at it available to the public, free, so that others can do the same. Second, its cost-measurement method has been vetted and endorsed by a group of providers, purchasers, and consumer advocates (Consumer Reports among them).

Quality scores for each group are based on 88 measures, including the percentage of patients who reach goals for high blood pressure, cholesterol, and diabetes, and how well it scores in patient surveys. The higher the score, the higher the quality. For a full explanation of the methodology, go to healthpartners.com/costandquality or myhealthscores.org.

Cost scores are based on all care that the group provides, including preventive tests, medication, and care for acute and chronic illnesses. In this case, the higher the score, the lower the cost. The "good value" column identifies groups that scored highly for both quality and cost.

As the chart shows, high-quality groups varied in their cost scores, as did groups that scored in the middle for quality. And the low-scoring group for quality was in the middle of the pack for cost. The bottom line: You can't judge quality by cost.

There are some limitations to the data. They come from just one health insurance plan, for one thing. And practices within each group may perform better or worse than the medical group as a whole.

The findings might surprise some patients—but not many health experts. After all, the U.S. health-care system outspends the rest of the world but has worse outcomes on many health measures than other industrialized nations. And we've reported on the overuse of medical tests and treatments that don't necessarily lead to better health but do lead to higher costs and medical risks. For example, back-pain sufferers in a 2010 study who had an MRI within the first month didn't recover any faster than those who didn't have the test—but had a fivefold increase in medical costs.

Several organizations in other states, including Michigan and Utah, are headed in the same direction as Minnesota, in some cases using the HealthPartners cost measure as a model. In the meantime, the effort in Minnesota shows that good health care isn't always the most expensive. And it points to a day when health-care systems will compete based on proven measures of quality and cost rather than on reputation, advertising, and hype.

The highest-quality care isn't necessarily the most expensive, as the chart below shows. Under "Quality" and "Cost," higher scores (3 or 4) indicate higher quality and lower cost, respectively. A bullet under "Good value" identifies groups that scored well on both measures.