HealthLeaders: Why is it important to have a neutral "convener," as you put it? Is more data by definition better data?
Steele: Yes. We've got a ways to go not only on EHR functional initiation but also with data warehousing. Organizations like Premier are creating their own data warehouse that can be used as outsourced capability for those who don't want to or can't build their own. When we do all our road tests, whether in hospital care re-engineering or focusing on a different way to provide ambulatory care for those who have chronic disease, our most important metrics are total cost of care and whether we have achieved lower cost of care without sacrificing near- and long-term quality.
HealthLeaders: Why is it so difficult to come up with usable information on the cost of care and whether the healthcare dollar is well spent?
Steele: You would think that looking at total cost of care would be an easy task. It's not easy at all. Being able to use data that is aggregated and understanding how to define precisely what goes into the calculation of cost of care has more credibility if you can do it with other organizations that are aspiring to same goal. Ideally you could do that from CMS data. But they're under such duress on analytics that often there's huge lag time between what you do and getting data fed back. Medicare Advantage data, which we have because we have a Medicare Advantage plan, is more accessible. We use that data as a surrogate to determine the effects of the changes we make. For physician demonstration projects, the data coming out of CMS is 15–18 months after the fact. If you're looking at actually getting docs and nurses and community resources to do things differently in caring for patients, that data has to be fed back to them almost in real time to be usable.