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Consumers are becoming hungrier for
information that lets them compare the cost and quality of care delivered by
Barbra Rabson (pictured at right), president and CEO of Massachusetts Health
Quality Partners (MHQP), sees it every time her organization updates its
Healthcare Compass website with new patient experience data
for more than 500 primary care practices in the state. “We always have big
bumps in readership when we do our public release of new data,” she says.
The scenario is similar for
Minnesota HealthScores, a website that provides quality, patient experience,
and cost data for more than 1,900 clinics, 450 medical groups, and 133 hospitals
in Minnesota and surrounding states.
But even as the amount of
comparative data proliferates, consumers’ ability to use it in their decision making
is still limited, says Julie Sonier (pictured
at right), president of Minnesota Community Measurement (MNCM), the multi-stakeholder
group that produces the HealthScores site. Across most of the country,
consumers who try to shop for high-value providers generally find disparate
data points that are difficult to interpret or irrelevant to their situation.
“Even if the information is there,
people don’t necessarily know it’s there,” Sonier says. “And they don’t know
what to focus on.”
But as consumers shoulder increasing
costs for healthcare services, it is imperative that the industry make it
easier for them to make good decisions, she says. “By putting responsibility on
consumers for paying more of the cost out of their own pockets, we have, as a
society, put a lot of responsibility in their laps to solve this problem,” she
says. “And they can't do it on their own.”
Many provider organizations have
started offering out-of-pocket estimates for consumers who schedule or inquire
about specific services. But comparing cost information for providers in a
given market generally requires the consumer to contact each organization
separately. And overlaying that cost information with quality data that allows
a consumer to assess value—quality and cost together—is nearly impossible.
That is changing in Minnesota, where
Minnesota Community Measurement has been expanding and refining its HealthScores
data for more than a decade to create one of the most comprehensive sources of
comparative provider information in the country. MNCM was founded by six
Minnesota health plans along with healthcare-purchasing organizations, the
Minnesota Hospital Association, and the Minnesota Medical Association.
Exhibit: Cost of a Colonoscopy in Minneapolis
The HealthScores website allows
consumers to compare providers—primary care, specialists, and hospitals—in many
ways. The site draws on a subset of HEDIS measures, patient experience measures
from a biannual survey, clinic-submitted quality measures (including 15
risk-adjusted measures), total-cost-of-care measures, hospital measures (drawn
mostly from information that hospitals submit to the Centers for Medicare &
Medicaid Services), health IT measures, and the average cost of more than 100
services and procedures. The HealthScores measures are constantly being
evaluated, updated, and—when statewide performance shows minimal
variation—removed so that the site supports meaningful comparisons.
Despite the vast amount of
information, most HealthScores users cannot easily tell which provider offers
the best value for a specific health condition. For example, it’s easy to
identify the medical groups that have the best outcomes for patients with diabetes
and which groups have the lowest total cost of care or the lowest cost for a
blood test. But putting those pieces of information together does not reveal
the cost of care for patients with diabetes, given that data sources simply do
not line up in a way that allows costs to be examined by medical condition.
Significantly, the HealthScores
website includes several patient-reported outcomes, such as pain, function, and
mobility after total knee replacement surgery. “That's another one of the
things that makes our organization distinct from others who do this type of
work,” Sonier says.
Despite the breadth of information
available on Minnesota HealthScores, Sonier has no way of knowing whether
consumers are using the site to shun high-cost, low-quality providers in favor
of high-value options. Scrolling through the website makes clear that Minnesota
providers—like those in all states—vary widely in the cost and quality of care
“Efforts to engage consumers with
this type of information and make health care ‘shoppable’ are really, really
hard,” she says. “No one has found that magic bullet yet.”
Indeed, MHQP, another pioneer of
public quality reporting, has pivoted to make patient engagement its top
priority. Its Healthcare Compass reports on patient experience measures from an
annual statewide survey but currently provides no data about specialty care and
no cost information.
In the early years, MHQP leaders
assumed that if consumers had comparative data available, they would use it.
But it may be that choosing the “right” provider based on comparative data is
less important than being an empowered patient who asks the right questions,
knows what constitutes good care, and interacts with clinicians in a true partnership.
“We are focusing more on the patients as they engage in the system—not from a
choosing aspect, but from the aspect of, ‘OK, I’m here and I need services, and
I want to do the best I can to get better. What are the ingredients for
success?’” Rabson says.
That work includes helping consumers
understand what questions to ask of their providers and how to proactively
discuss prescription and treatment recommendations, rather than remain passive and
unsure about the clinician’s approach. Most recently, MHQP convened patients
and a wide range of clinicians in a “co-design” activity to find better ways to
assess and address pain. “We believe without patient engagement, we are never
going to achieve the outcomes that we want in our healthcare system,” Rabson
Health systems and health plans can
take several steps to support consumerism by advancing the use of publicly
a collaborative approach. Although
provider organizations may be tempted to generate their own quality-performance
data, that may be less effective than collaborating with a large group of
community stakeholders. “People tend to trust the information more when it's
not coming directly from someone who is seen to have a vested interest in it,”
Even if consumers trust a provider
organization to report accurate quality data, that information is not very
useful if it can’t be compared with data from other providers. The benefit of
an independent collaborative such as Minnesota Community Measurement is that
stakeholders come to a consensus about what measures are worthwhile; how
measures are defined, calculated, and reported; and how data submissions can be
audited. “We have some pretty thorough processes for validation that have been
key to our success,” Sonier says. “That is the reason why people trust the
information that we put out.”
data from independent sources. Physicians initially tended to be wary of the quality
reports issued by MHQP, but many now recognize that their patients want
transparency. “There are an increasing number of physician organizations that
ask our permission to post our data about them on their websites,” Rabson says.
“They see that transparency can add a lot of value for their patients, that
being open about their performance and willing to share it is something that is
seen as a very positive move.”
An insurer that belongs to MHQP also
posts Healthcare Compass data on its website, allowing its members to compare
the quality and patient experience data for various clinicians in its network,
it easier for patients to benefit from data. Sonier points to insurance benefit designs that offer
financial incentives—lower employee premiums, deductibles, and/or copays—if
patients choose providers that can prove they deliver high-quality, low-cost
care. “That is an effective way to use the information,” she says. “Those kinds
of consumer incentives have the potential to go a long way toward helping
consumers make decisions that take quality and cost into consideration.”
Lola Butcher writes about healthcare business and policy topics for
several HFMA publications.
Interviewed for this article: Barbra Rabson, president and CEO, Massachusetts Healthcare Quality
Partners, Watertown, Mass.; Julie Sonier, president of Minnesota Community
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ICD-10: Managing Performance
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Yuma Regional Medical Center case study
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