Chapter VI. Building Communication and Dissemination Infrastructure
Evaluation of a Learning Collaborative's Process and Effectiveness to Reduce Health Care Disparities Among Minority Populations
This chapter examines the communications and dissemination infrastructure of the Collaborative, based on information collected during round three of our interviews14 (bottom of Figure VI.1). As in previous chapters, we first present a summary of our findings. We then describe the rationale and background of Collaborative communications, followed by a discussion the Collaborative's major communication and dissemination activities in Phase I. We end by discussing the perspectives of participating firms and other organizations on communications support, including the successes and challenges, and what the Phase I experience highlights as important issues to consider in Phase II.
A. Overview of Findings
Firms, support organizations, and sponsors alike generally had a positive assessment of the communication and dissemination activities of Phase I of the Collaborative, although many recognized that there was little to communicate or disseminate yet and use of existing communications materials appeared limited. Nonetheless, the communication work done over the last year—which included the development of the NHPC logo, materials, and standardized messaging—was viewed as an important foundation for Phase II, when NHPC (and perhaps individual firms) will have more to report about their activities in the area of reducing disparities.
B. Rationale for Communications and Dissemination
Reaching out beyond the Collaborative to other audiences is a core activity, one that will have an influence on the Collaborative's overall ability to expand health plans' awareness of and attention to the issue of disparities. Key support organizations planned to support this focus in their own ways. For example, CHCS had plans to develop a toolkit and also to share lessons more broadly with plans as part of their upcoming Quality Summit on reducing racial/ethnic disparities. RAND hoped to work with Collaborative members to publish articles describing the Collaborative's experience and encouraging attention to these issues. Each participating organization (firms and nonfirms alike) also had its own interests in how communications about the Collaborative were to be handled.
In summer 2005, RWJF funded GMMB to provide communications support to the Collaborative. RWJF staff indicated that the primary goal of the communications contract was to help provide consistency and standardization in how the Collaborative was described externally to stakeholder organizations, policymakers, and others, and to establish a "brand identity" (including a logo). These goals were fairly simple and straightforward, and RWJF staff did not expect much media attention during this phase of the Collaborative.
The communications support and tools provided by GMMB were designed primarily for firm leadership participating in the Collaborative, although communications or public relations staff at most firms were also involved in the development of Collaborative materials—both so they could provide feedback and fully understand the purpose of the materials.
C. Major Communication and Dissemination Activities
Shortly after the start of its contract, GMMB developed a communications plan that established a series of guidelines and goals for the Collaborative's communication activities. The communications plan also provided some boilerplate language describing the Collaborative. The core messages of the Collaborative were as follows:
- In response to years of well-documented and persistent racial and ethnic disparities in our nation's health care system, nine leading health insurance companies have combined forces to form the National Health Plan Collaborative to seek out and test best practices to address the problem. While others in America's health care system—purchasers, patients and providers—also have critical roles to play, the Collaborative represents a collective effort by health insurance companies to do their part to solve this unacceptable problem.
- The Collaborative is a groundbreaking project bringing together major health insurance companies with organizations from the public and private sector to identify ways in which the quality of health care can be improved for racially and ethnically diverse patient populations. Participating health insurance companies are exploring interventions aimed at communities, providers, and other stakeholders. The initial focus of the Collaborative is on improving the quality of care for patients with diabetes. Over the next year and a half, the National Health Plan Collaborative will work to engage other health care decisionmakers—major health care insurance purchasers, health care providers and policymakers—to join ongoing efforts to find solutions to racial and ethnic disparities in health care.
- In January 2007, strategies and lessons learned from the Collaborative will be shared with other health care decisionmakers and leaders.
The communications plan also made several recommendations about venues for disseminating the Collaborative's work (including the roundtable briefing and America's Health Insurance Plans' Building Bridges conference, described in more detail below). Finally, it also indicated that GMMB would provide members with information of interest to the Collaborative as a whole, thereby creating a vehicle for firms to discuss publications and other documents related to disparities—both those generated by Collaborative and those developed externally. One example was Nicole Lurie's editorial in the New England Journal of Medicine, which listed Collaborative members (Lurie 2005). Another example was a paper on by Asch et al. (2006) that was externally generated but of interest to many firms participating in the Collaborative because of its controversial finding that differences in health care quality by sociodemographic subgroups are small in comparison to the gap between observed and desirable levels of health care quality for each subgroup.
Per the communications plan, GMMB produced several tools in Phase I of the Collaborative. The first was the toolkit designed to establish standard messaging and branding of the National Health Plan Collaborative. Produced in December 2005, the toolkit included a brochure on NHPC, a list of frequently asked questions (the answers to which firms can use to address inquiries about the Collaborative), a racial disparities fact sheet, and information on usage of the Collaborative's logo.15 The toolkit also provided talking points about the Collaborative for firm leadership to use in public forums, and included a Microsoft Powerpoint presentation template with the Collaborative's logo and other basic information. A few members of the Collaborative used the materials in the toolkit—along with direct support from GMMB—to prepare for an Alliance for Health Reform briefing in Washington, DC, in late 2005.16
GMMB also created the Collaborative's Website, which was made public in February 2006 (http://www.chcs.org/NationalHealthPlanCollaborative/index.html). Drawing on many of the materials included in the NHPC toolkit, this Website provides basic information on the Collaborative, including its mission, participants, activities, a fact sheet on disparities, and a list of frequently asked questions. No information is available about use of the site (such as the number of hits or user sessions), although support organizations suspect that Collaborative participants are probably the most frequent users of the site.
The most prominent communications activity during Phase I was the Collaborative's roundtable briefing in Washington, DC, in June 2006. (This briefing was held immediately before the start of RWJF's second annual conference on disparities and quality of care, in the same venue.) As part of this one-and-a-half hour briefing, senior leadership from AHRQ and RWJF introduced the session and lead contacts from each of the nine participating plans presented briefly on their firm's activities as part of the Collaborative. Over 50 people attended this briefing in person, and over 200 people registered to listen to the Webcast of the briefing via the NHPC Website.17
One of the final communications activities in Phase I of the Collaborative was a presentation at America's Health Insurance Plans' (AHIP) Building Bridges conference in early November 2006.18 Specifically, GMMB worked with AHIP and Collaborative participants to organize a session in which lead contacts from three participating firms, along with Stephen Somers from CHCS, each presented on various aspects of the Collaborative. GMMB also recently produced a summary report on the Collaborative—which drew from MPR's interim report and other sources—for distribution at the conference.19 The report includes information on who is participating in the Collaborative, what participants came together to accomplish, activities to date, and next steps. The summary report culminates with a "call to action," which makes several recommendations to the health care community, including (1) standardizing primary data collection criteria, (2) encouraging other health plans to participate in Collaborative initiatives, and (3) encouraging other health plans to address the problem of disparities.20
Each core support organization is also engaged in using its own strengths and resources to further disseminate the Collaborative's message and reach target audiences in a variety of ways. For example, RAND and CHCS staff recently drafted a manuscript describing the Collaborative and its work to date, which they will submit for publication to the American Journal of Managed Care. In addition, although it is not an official Collaborative activity, CHCS has included several Collaborative participants as presenters at its upcoming Quality Summit on Improving Health Care for Racially and Ethnically Diverse Populations in December 2006.
D. Perspectives on Communications Support
Use of communications tools. Use of GMMB tools and support varied somewhat by firm, although no firm appeared to be a heavy user. While a few firms have contacted GMMB for additional copies of toolkit materials or other support, staff from several firms noted that they have not yet needed communications support because they have no concrete actions yet to report and have not received any inquiries about the work. Most firms did not use the Collaborative toolkit directly (although a few firms circulated toolkit materials to staff internally); nonetheless, many appreciated having the information available to them. A couple of firms suggested that the toolkit could have had more information, such as specific examples for communications staff of how the materials could be used. Use of the Collaborative Website also appears to have been rather limited to date.
It is important to note that during Phase I, the Collaborative's communication tools focused on policy issues rather than firms' operational uses. In this phase, firms were generally not at a stage where they could actively promote their interventions or other Collaborative activities to key customers—such as purchasers, consumers and providers—and the utility of these tools must be understood in that context.
Both firm and nonfirm perceptions on the roundtable briefing in June 2006 were uniformly positive. All thought the briefing was a good way to publicize the Collaborative's work and believed that GMMB played an important role in presenting a unified message from the Collaborative as a whole and standardizing the presentation format used by all firm representatives.
Successes. Staff from several firms and support organizations agreed that the communications work in Phase I was helpful in setting up a foundation and allowing the Collaborative to be ready for communications and dissemination in Phase II. Many saw establishing a Collaborative logo and standardizing the message as a very positive development. In the words of one lead contact, the Collaborative "got an identity" from the communications work. Moreover, the communications work to date—especially for the roundtable briefing in June 2006— helped firms to see that the Collaborative's "message would have more power if they were all saying the same thing consistently," according to one sponsor.
Almost all firms found GMMB to be professional, organized, and helpful. Firm staff believed the materials for the roundtable briefing were well done and commended GMMB for its help in preparing for the briefing and its persistence in getting firms to present a unified message.
Challenges. The primary challenge to date has been the relatively little activity about which to communicate at this early stage of the Collaborative. In the words of one support organization staff member, "the Collaborative has to have something to say before communications can help." Most firms agreed that the ability to communicate and disseminate was limited at this stage, and additional communication would have been premature. As one firm representative suggested, "our first priority is getting something solid done and rolling it out." Only after this point will firms—and the Collaborative as a whole—have something significant to communicate.
While RWJF charged GMMB with communicating a consistent and unified message for the Collaborative as a whole, it is worth noting that firms may have other distinct communication needs. Although firms are clearly interested in promoting the work of the Collaborative externally, a couple of the participating firms—all of which are large, complex organizations—were also interested in communicating about the work within their own organizations. One firm, for example, believed GMMB was substantially less helpful to individual firms in communicating their own work on disparities—either internally or externally—than promoting the Collaborative as a whole (the latter of which was GMMB's charge).
Support and sponsor organizations noted that the competitive dynamics between plans affected the group's ability to communicate, at least in the earlier stages of Phase I. One support organization said it was initially "extremely difficult to get them to communicate as a group, just given the number of players involved"— and taking it one step further to communicate a single unified message externally was even more challenging.
Several characteristics of participating firms also influenced GMMB's ability to perform its communications function. For example, the size of firms participating in NHPC has sometimes made it difficult for GMMB to know if it reached the appropriate communications people. (Moreover, the chain of command in these large firms often slowed response time to signing off on Collaborative materials or other documents.) Another challenge involved turnover among communications staff at several of the firms, which made it difficult for GMMB to sustain relationships over time.
Perspectives Moving Forward. When asked about the possible role of communications in Phase II of the Collaborative, staff from many firms expressed an expectation for increased communications and dissemination, as there will be more concrete activities to cover. Moreover, consistent with findings elsewhere in this report, there is a strong perception (among firms and nonfirms alike) that firms are becoming more comfortable sharing with one another as a group, which is gradually improving communication within the Collaborative. According to one support organization, this may give the Collaborative more ability to speak collectively in Phase II. Finally, staff from several firms indicated that employers/customers are getting more interested in disparities and the actions health plans are taking to address those disparities. If this trend continues, actively promoting the work of the Collaborative may become more useful over time.
In terms of future communications activities, a few communications staff stated that helping promote success stories as they become available would be helpful in phase two. Other firm staff suggested that GMMB could help them promote Collaborative activities within their firms (Collaborative participants are large firms that typically need help communicating internally.)
Sponsor organizations indicated that future communications goals will become clearer as participating firms reach consensus on their overall goals for Phase II. GMMB is currently preparing a proposal to RWJF for communications activities in the Collaborative's next phase.
As the Collaborative moves into its next phase, one possible tension in the communications realm involves organizations' desired focus versus that of the Collaborative as a whole. While sponsors want to ensure that the messages of the Collaborative are presented consistently to policymakers and stakeholders, at least some of the firms may be just as concerned with communicating firm-specific activities to other audiences—such as purchasers, providers, and possibly consumers—that are key to firm success. As the Collaborative moves into its next phase and reporting increases, it is important to consider how these preferences might be aligned.