Chapter 4. Establishing Credibility and Value
Regional Coalition Collaboration Guide
Establishing the credibility of your coalition is crucial to recruiting participants and effectively leading a regional coalition. Achieving credibility means having others recognize the coalition's capabilities and knowledge.
Business literature identifies numerous characteristics of organizational integrity, including accountability, honesty, candor, and transparency. A number of specific factors also affect the perception of a coalition's credibility, such as its process for data analysis and validation, how errors are addressed, and what experts and specialties support the initiative. Coalition leaders have identified the following approaches to enhancing credibility in the early stages of a coalition among stakeholders, the media, and the public.
Partner With High-Profile Organizations and National Initiatives
The Center for Health Information and Research used its involvement in national projects to help establish its credibility among major players in the Phoenix area. Its participation in a successful national quality initiative sponsored by CIGNA, for example, generated local interest in forming the Phoenix coalition. Partnering with a national human resources policy association also established its credibility among local employers. However, convincing large national plans to participate in regional coalitions can be challenging because their objectives sometimes conflict with regional goals.
Have Strong Connections Within the Local and Regional Community
To reinforce its integrity, an emerging regional coalition also should connect with credible organizations that have strong ties in the health care and business communities.
Health care community. Minnesota Community Measurement made a crucial, strong connection with the Institute for Clinical Systems Improvement, an organization in Minnesota within the physician and provider community. The institute works with medical groups to establish quality improvement cultures and infrastructures, including internal measurement. It also develops guidelines that are based on local and national best practices and use evidence-based processes. Minnesota Community Measurement bases its measures on these guidelines, which are approved by local and regional physicians. Aligning with this highly credible local organization strengthened Minnesota Community Measurement's credibility among physicians and providers. The coalition is working to cultivate consumer participation by reaching out to local organizations that consumers see as credible, such as the Minnesota chapter of the American Diabetes Association.
St. Luke's Health Initiatives, which helped to establish the Arizona HealthQuery with the Center for Health Information and Research in Arizona, also is well connected in the Phoenix health care community. It was able to draw stakeholders from its many contacts in the State's hospital and medical associations, the local Quality Improvement Organization, and the State legislature.
Because it realizes the importance of having valid and reliable measurements, Massachusetts Health Quality Partners has established relationships with many world-class health care researchers in the Boston area. Massachusetts Health Quality Partners' credibility benefits from the experts' involvement in the data analysis portion of the research, and the researchers benefit from having access to a large, broad-based database.
The California Cooperative Healthcare Reporting Initiative works closely with the California Medical Association. A California Medical Association representative sits on the coalition's Executive Committee and provides perspective on issues that affect physicians. Additionally, the California Cooperative Healthcare Reporting Initiative also works closely with the California Association of Physician Groups to enable an efficient communication path to the physician groups and physician leaders within the State. The California Association of Physician Groups' medical director sits on the California Cooperative Healthcare Reporting Initiative's Better Quality Information Pilot Steering Committee.
Business community. The Wisconsin Collaborative for Healthcare Quality founders recognized the importance of building credibility and trust with the business community, a key customer of each member organization. Each founder invited a business partner to participate in all the collaborative's meetings, including those focused on selecting the initial performance measures. Business partners included private employers, business coalitions, a large union, and a State association of business and commerce. These invited partners connect the Wisconsin Collaborative for Healthcare Quality to each local market directly, enhancing the legitimacy of the collaborative's vision.
The Indiana Health Information Exchange has cultivated a relationship with the Central Indiana Employers Forum, which consists of several employers, hospitals, physician groups, and payers. The forum initiated development of a pay-for-performance quality health program led by the Indiana Health Information Exchange. Consequently, the coalition immediately gained the support of important players in the region. The Indiana Health Information Exchange also worked closely with the Central Indiana Corporate Partnership, an alliance of chief executive officers from the region's largest employers and its university presidents. Lastly, the Indiana exchange's board of directors includes hospital chief executive officers, the mayor of Indianapolis, local public service health care leaders, payers, and other people needed for ongoing support of the collaborative.
Emphasize the Collaborative Nature of the Coalition
Providers drive some Better Quality Information sites; purchasers drive others. Regardless of the driver, keep in mind the need for underscoring the value exchange's collaborative nature.
For example, professionals with medical experience drive the Wisconsin Collaborative for Healthcare Quality. This has given the coalition credibility among clinicians. However, coalition leaders recognize that to be truly effective, their efforts must be part of a larger community network. Consequently, purchasers also play a large role in influencing the direction and governance of the coalition.
The success of a coalition will, in large part, be based on the value it can provide participants. Each major player in a multistakeholder coalition brings to the table a different agenda with key goals and objectives. A critical challenge for coalition leaders is to create value for each player in order to keep it at the table.
A critical step in forming a coalition and identifying stakeholders is developing strategies for addressing the "what's in it for me" motive many will have. Identifying and communicating the value of the coalition and working to continuously provide that value will be one of the most important challenges in maintaining a coalition.
Show Value to Entice Participants
To attract purchasers as participants, the Wisconsin Collaborative for Healthcare Quality emphasized that participation in the coalition would allow access to comparative performance information that otherwise would not be readily available. Participation would also allow purchasers to directly influence the selection of performance measures. As a result, these stakeholders had an opportunity to improve their business based on information at their fingertips. This sort of value was an attractive incentive for purchaser participation, and it was important for the Wisconsin collaborative to highlight this value when inviting purchasers to join.
In addition to access to a rich compilation of data, one of the most appealing benefits a coalition can offer stakeholders is saving them time and money through services the coalition provides. When the Massachusetts Health Quality Partners initially formed, hospitals needed to respond to multiple requests from health plans for reporting hospital quality data. Hospitals became frustrated with the number of requests from different plans, which were redundant and resulted in wasted time and resources and increased frustration. The Massachusetts coalition was innovative in coordinating and streamlining the numerous quality data requests into a single format that all plans accepted. Health plans were satisfied because hospital quality data requirements were fulfilled in an accurate, concise format. Hospitals were relieved because now there was one convener—Massachusetts Health Quality Partners—between hospitals and health plans that alleviated some of the frustration and wasted resources while ensuring that reporting requirements were satisfied.
Streamline Complicated Processes
An effective way to demonstrate a coalition's value to participants is to demonstrate how it will simplify data collection for them.
The Wisconsin Collaborative for Healthcare Quality has designed an innovative model of direct data collection from its participating medical groups. Through the development and application of an "all payer, all patient" method of measurement, medical groups collect both administrative and clinical data internally and submit calculated performance results to the collaborative through a secure, Web-based tool. This method obviates the need to aggregate administrative data from multiple health plans, incorporates clinical data for more robust measurement, creates a standard set of data files for validation and auditing, delivers a ready-made registry for patient management, and generates a high degree of physician engagement and support for public reports.
Many years ago, the reporting landscape was wide open. Health plans were not conducting surveys or requesting much quality data. However, through quality initiatives and the National Committee for Quality Assurance requirements, quality reporting flourished, and health plans began requesting quality data from hospitals. Massachusetts Health Quality Partners identified a need for coordinating and rationalizing requests from health plans regarding quality data, and hospitals identified value in the uniformity of forms, data definitions, measures, timelines, and processes for meeting demands the health plans were placing on them. In addition, physicians were receiving multiple statewide preventive care guides from numerous health plans. The Massachusetts coalition consulted with health plans and developed one set of unanimously accepted guides to be sent to physicians. Both the physicians and health plans were grateful for this standardization. Being able to recognize the need for coordination, standardization, and rationalization was an effective strategy for creating value and should be considered when looking to create value for stakeholders within your own coalition.