1. Summary of Key Implications for the Research and Action Agenda
This chapter serves as a brief summary of the major implications for the Research and Action Agenda that came out of the discussions and presentations that took place at the Informing Consumers About Health Care Quality conference.
Implications for Task 1. Educating and Motivating Consumers to Use Quality Information
- The KFF/AHRQ survey results suggest that it may be difficult to convince consumers that they need additional information, as the vast majority of individuals are "very" or "somewhat" confident that they have the information they need to make health care decisions. These views are in part driven by the following:
- Most consumers believe that the quality of health care is determined by their physicians
and that their physicians offer high-quality care.
- Consumers tend to define quality as being equivalent to choice of providers.
- A social marketing approach might be the most effective strategy for the difficult task of convincing consumers to change behavior with respect to using information on quality in making health care decisions.
- Advocacy organizations that represent the interests of specific consumer segments may be effective intermediaries, particularly in reaching minorities or consumer cohorts that suffer from specific chronic illnesses.
- Key messages in any education campaign should include the following: that significant quality problems exist in the U.S. health care system; that quality varies across plans and providers; that quality does not equal choice of providers and does not relate to the amount of services delivered; and that standardized information on quality from credible sources can assist consumers in making health care decisions.
- An education campaign should consider targeting not only consumers, but also price-sensitive small- and medium-sized employers and providers, the vast majority of whom still believe that the quality of care in the U.S. is acceptable.
- The message of such a campaign should likely be positive in nature, emphasizing values that people care about, such as looking after a loved one. That said, messages emphasizing the ability to improve one's own health do not tend to work well. In addition, negative messages run the risk of turning off consumers and/or those entities being measured (e.g., health plans, provider organizations).
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Implications for Task 2. Improving the Supply and Delivery of Consumer-Oriented Quality Information
- Information on quality must be consistent across purchasers and other organizations that produce it. In other words, there is a tremendous need for standardized measures, measurement methodologies, and reporting formats.
- The KFF/AHRQ survey results bring into question the credibility of employers as a source of information. But several panelists were skeptical about this finding, believing that employers are in fact a credible source of information. Further research on this topic may be necessary.
- Because many consumers—especially seniors—rely on the recommendations of friends, family members, and physicians in making health care decisions, it is critical to gain a better understanding of how to use these trusted intermediaries as a means of getting information on quality to consumers.
- Information needs to be communicated in a variety of languages and formats.
- Information should be delivered to coincide with "teachable moments," such as just before an individual becomes eligible for Medicare.
- Information must be relevant to the individual consumer's unique circumstances, which are defined by the consumer and likely relate to his or her ethnicity, cultural background, specific medical condition/situation, and local market.
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Implications for Task 3. Developing Consumer-Oriented Quality Measures
- The KFF/AHRQ survey suggests that most consumers believe that the type of information that is currently available would be useful in helping to make health care decisions.
- That said, relevant quality measures are just beginning to be developed for many specific consumer segments, including seniors, cultural and ethnic minorities, and those with special health care and communication needs. In addition, relevant measures are not yet available for some services used disproportionately by certain populations (such as home health services, which tend to be used by seniors).
- Many consumers are interested in provider- and facility-specific measures. While some measures at the provider group level are now available, virtually no information on the relative quality of individual providers exists today. Yet there is a need for such information, as there are significant variations in quality across these providers.
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Implications for Task 4. Identifying Market Characteristics and Purchasing Strategies That Support Consumer Use of Quality Information
- Only consumers who actually have a choice of health plans will be interested in information on the quality of competing plans. That said, because virtually all insured individuals have some choice of providers, provider-specific information is relevant to a broader set of consumers.
- In those situations where consumers do not have a choice of plans and/or providers, the goal of quality information initiatives should be to stimulate quality improvement among those entities being measured.
- Of all the key stakeholders, purchasers are the only group for which a compelling business case can be made today for health care quality. As a result, they must lead the way to creating the kind of market environment in which consumers will seek out information on health care quality.
- An economic downturn could quickly lead employers to adopt defined contribution systems that would get consumers more directly involved in choosing insurers and their affiliated providers. At this point, consumers would likely become more interested in information on health care in general and quality in particular.
- Many panelists felt that risk-adjusted payment systems are necessary to ensure that plans and providers are not penalized for offering better quality to high-risk consumers. Additional research is needed to test this hypothesis. In addition, those promoting use of information on quality may not want to wait until risk-adjusted payment systems are perfected before developing systems to measure performance in serving high-risk populations.
- It is critical that any risk-adjusted payments to health plans filter down to the providers that actually care for these populations.
- Purchasers should consider use of financial incentives for plans and/or providers that meet or exceed quality improvement targets. Without such incentives, there is no business case for quality for the plans and providers. Employers might also consider offering employees incentives to choose higher-quality plans or providers.
- Consumers with special health care needs may be reluctant to switch health plans or providers, even in the face of evidence suggesting that they are receiving suboptimal care. The reasons for this are two-fold. First, these consumers often value continuity of care with a given provider. Second, they may feel as if they have few choices available to them. Consequently, it is important to consider whether there might be a role for government in ensuring quality in circumstances where a patient may not want or be able to switch plans or providers.
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Implications for Task 5. Evaluating the Utility and Impact of Consumer Information Efforts
- Because individual purchasers often lack the resources to evaluate their consumer education efforts, it is important to develop a standardized framework for evaluating such programs that can be applied across purchasers.
- Before implementing and evaluating consumer information programs, it is important to define the concrete goals for the initiatives, particularly those oriented at specific populations such as individuals with special health care needs.
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