In their boats . . .

There is an old joke about a university with a certain ethnic background (mine) that decides to set up a rowing team. After months of practice, the crew arrives at the Head of the Charles Regatta to compete. They are demolished -- recording by far the worst time of any 8-person boat.

Discouraged, the coach sends out the captain of the team to visit with other college teams to figure out how to get better at the sport. Hours later, Sam comes back and says, "Coach, I figured out the secret of their success!"

"What is it?" asks the coach.

"In their boats, eight people row and only one person talks!"

Apropos of that, please see the photo below of a sculpture from Jaffa, Israel, which seems to exemplify the lesson:

Those who have worked in hospitals already see the relevance of this story, but I present it more to provide a warning of what I see happening in the Massachusetts state government.

You may recall a post from a few months ago in which I set forth great hope about the usefulness of an all-payer claims database. Here's an excerpt:

Over the coming months, in accordance with an act passed last summer, the Division [of Health Care Finance and Policy] will be constructing an all-payer claims database (APCD). It will comprise medical claims, dental claims, pharmacy claims, and information from member eligibility files, provider files, and product files. It will include fully-insured, self-insured, Medicare, and Medicaid data. It will also include clear definitions of insurance coverage (covered services, group size, premiums, co-pays, deductibles) and carrier-supplied provider directories.

The Commissioner noted that the result will be "a dataset that allows a broad understanding of health care spending and utilization across organizations, population demographics, and geography." In my view, it will be a moving force in rationalizing payments to providers across the state....

One of the things then-Commissioner David Morales promised was that the database would be widely accessible, so that independent researchers, policy analysts, advocates, market participants, and others would be able to manipulate it to test hypotheses and assumptions. Well, the Commissioner has since announced he is leaving his post, and it already has become evident that there is no one in the government who is steering the boat along the lines he so clearly presented. Instead, there appears to be the classic bureaucratic situation: Too many people involved, none with authority, and certainly no one exercising the leadership needed to make this incredibly useful tool available to the public.

It is time for one person in the Executive branch to talk, and for the others to row, to make sure the Legislature's intent with regard to the transparent presentation of these claims data occurs in a timely and useful fashion.