Healthcare Consumerism Requires Comparable Quality and Cost Data
Provider organizations and health plans can advance the use of cost and performance data to support consumerism, as collaboratives in Massachusetts and Minnesota are showing.
Consumers are becoming hungrier for information that lets them compare the cost and quality of care delivered by various providers.
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.”
Putting It All Together
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.
Emphasizing Patient Engagement
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 they deliver.
“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 says.
What to Do Now
Health systems and health plans can take several steps to support consumerism by advancing the use of publicly reported data.
Take 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,” Sonier says.
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.”
Use 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, Rabson says.
Make 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 Measurement, Minneapolis.