PODCAST/CONSUMERS/TECH: Interview with MaryAnn Stump CEO, Consumer Aware–HealthFacts.org

This is the transcript of my interview last month with MaryAnn Stump CEO, Consumer Aware. Consumer Aware is the BCBS Minnesota subsidiary that puts out the web site HealthCareFacts.org which ranks and rates hospitals and clinics. Unfortunately I had some technical problems with this podcast recoding, but 95% of what Mary Ann was saying is here—and she said a lot! The original audio podcast is here

Matthew Holt:  This is Matthew Holt with The Health Care Blog, and I’m back with another podcast on the blog. Today I’m very excited that I’m talking with Mary Ann Stump, who is, among her many other titles, the president of Consumer Aware. Which, Mary Ann, you’ll explain to us, is a subsidiary of Blue Cross of Minnesota. Tell us a bit more about what you do, and about what else you’re doing at Blue Cross of Minnesota.

Mary Ann Stump:  Ok. Well first of all, good to talk with you Matthew. I appreciate the opportunity. About a year and a half or so ago…I’ve been working with Blue Cross/Blue Shield of Minnesota for about 16 years now. About a year and a half ago, when I had been working diligently in this whole space of consumer information‑‑that became known more formally as "transparency"‑‑our CEO and I were talking one day. I said, "You know, I think we really need a team. Sort of a garage type of situation, a learning laboratory where we can really start devoting‑‑with a particular number of people that have an interest in advancing a whole vision around effective and useful consumer information‑‑ someplace where we can sort of work on this in addition to thinking about the business the way that it is today."

We had an affiliate organization that essentially was doing managed‑care tools. Really as you know, the whole managed‑care movement is not only changing significantly, but I think the kinds of things we were doing historically are not the kinds of things that we’re going to need as far as the future is concerned.What he suggested was: Why don’t we take that particular affiliate organization‑‑that I like to think about as a garage so to speak‑‑and say let’s set off deliberately to start to look at how we were going to do things differently as far as consumer information is concerned. Based not only on what we know but where we want to start to see people moving. From being the usual recipient approach to health care and really with the consumer at the center, being customers of care. What are the kinds of tools we would develop in that regard? I’d already been working on a couple things, and so essentially we formalized not only the expectations but the opportunity to be able to accelerate that. So Consumer Aware was born.

I’m with you. So you’re essentially you’re the one who has put out the
suggestion and then been told that you had to do it. [laughter]

Mary Ann:
Exactly, exactly! What’s been really neat about it is that the whole
evolution of this, I think…It started off as I think it is in a lot
of organizations. That people kind of think‑‑how do you put this out
relative to the way that we’re doing things today. You sort of tamper
around the edges with it as opposed to stepping back and saying: "Gosh,
If I could start to think about reinventing this in a different way
based on a new view of what success might look like." My background is
actually critical‑care nursing, so I really have come from not only the
delivery model, but I think the nursing discipline has always really
put the consumer at the center of the universe. The chance to be able
to suggest‑‑how could you start rethinking this in a way in which the
consumer was the center of the universe‑‑was pretty exciting for me. By
Golly, it’s like be careful what you wish for, because I sure did get

Right, right. So let’s jump to the end with Consumer Aware which now
has a website, and you probably have some other materials that you’ll
tell me about in a moment. I had a good poke around the website, and
your working…currently your parent company is a customer as is Blue
Cross of Louisiana?

Mary Ann:  Blue Cross of Louisiana, Blue Cross of Nebraska, and Blue Cross of Minnesota. Right.

Great. So you got three Blues up on, and at the moment, if I’m a
member of one of those plans I can come to Consumer Aware, and
essentially what I’m seeing is I think you described it as a sort of
nutritional guide to providers.

Mary Ann:  Correct.

So, tell me a bit about what it is that the consumer is seeing, what
kind of things you’re providing. Then we’ll get into a discussion about
whether those are the right things, and how it’s going to evolve.

Mary Ann:
Ok. Well first of all, the one clarification that I want to make and I
think this is a really good thing, because I think that this is the way
that we as consumers think‑‑is that it has nothing to do with whether
you’re a member of Blue Cross of Minnesota or Blue Cross of Louisiana,
or Blue Cross of Nebraska. It actually is available to all consumers.So
the information that goes on there…and we started with large
hospitals, starting to describe what large hospitals looked like. It
includes all of the information that basically are the attributes of
that particular institution. For instance if you look at‑‑one of the
metrics we have out there is the nurse-to-patient ratio. That is the
nurse‑to‑patient ratio within that institution, not available just to
Blue Cross members. I think that’s one thing that I think is
particularly distinctive about the approach that we’re taking even
though it’s grounded from a health‑plan perspective. The only thing
that is actually based on any information that specifically relates to
our business at this point is the price, the pricing information when
we start drilling down to actual price‑points. That’s only available to
members. But everything else is available to the general public and
it’s available through healthcarefacts.org.

Let’s talk a bit about what the categories are that you have
information on. As I said, you’ve been trying to promote the idea that
it looks somewhat like a nutritional food label.

Mary Ann:  Right, right.

But what are the categories? We’re used to sort of seeing the
ingredients, and the percentage of fat, percentage of carbohydrates,
percentage of sugar, and that kind of stuff. What are your equivalents?

Mary Ann:
Ok. Well, one is around obviously prices, we do have a price‑point
there. We also have things like the number of practitioners, or the
number of providers, the percentage of charity care, and some general
kinds of things that are out there. Then we have categories around
accessibility. We have categories around safety and quality. We have
categories around services and technology available. Although the
framework looks the same‑‑so it looks like a nutrition label‑‑for
instance, in a hospital. It also looks like a nutrition label in a
primary‑care clinic, but the categories are different and appropriate
to that particular site.

Most of these are some basic things which the consumer may or may not
care about. They may not care about charity care and that kind of
stuff. They may care a lot more about parking and what you’ve
said‑‑access. I see you’ve been through…physical access and can you
find the bus line and so on. That kind of stuff‑‑they may care about. I
guess the other sort of narrow issues such as some of the measures that
have been around for quality and safety and stuff–what are the ones
that you think are driving the site? Maybe another way to ask the
question is, what are your thoughts when you’re putting this together,
what do they want to know about?

Mary Ann:
First of all they wanted some sort of a frame in which they could
actually even make sense of it. We’ve done quite a lot of consumer
research and what we’ve tried to do is actually listen to what folks
had to say and then design around it. One thing they said to us is
"Could you make this simple, in a way that’s meaningful to me where
there’s substance. But, by golly I don’t want to have a PhD in this
stuff, so make it simple." One of the reasons why I was intrigued quite
frankly with the idea of using the nutrition label in order to be able
to translate this stuff is I thought most of the stuff that’s out there
not only is boring but it’s also pretty intimidating.You get in
there and immediately your eyes glaze over. How I got the idea of
actually starting to use the nutrition label as a frame was, I was
sitting there, probably around 5:30 one night, around the same time it
is right now, and I was drinking a diet Coke and I was eating a candy
bar. I was just staring at the nutrition label on the can of diet Coke
and I thought to myself you know that’s kind of interesting. This is
right in front of my face. I see this every day. It’s something that
even my daughter who had been a figure skater and at eight years old
she was looking at things that were on there basically because her
figure skating coach told her about it.So this starts to
address some of the issues around framing something that is not going
to be intimidating. It’s essentially going to be inviting to consumers
in a way in which they might even start to take a look at it and have
an opportunity to be able to drill down a lot more depending upon what
the question might be. So the very first thing we tested with consumers
was if they liked the frame. You don’t need a class in order to be able
to figure out how to use it, which is why we already started looking at
even the placement of things like for instance the address and the
price always goes in the same place much the same as calories would go
in the same place on a nutrition label. So you could start to get some
familiarity and comfort with the territory about it. So the very first
thing we tested with consumers was if they liked the frame. We had
essentially two rules in terms of even developing the prototype. One
was, this is page one of the tool. There is no page two. Unless you
wanted to drill down but it was always, keep it simple.The
second thing was that we really did cast all of the metrics that we put
on, starting with the large hospital and then evolving to the smaller
and the community hospital and now the primary care version of it. We
tested it with consumers to say, what’s important to you and what
isn’t, so that at the end of the day it was the consumer that was the
final arbiter of things that went on it.So as a result we got
some really interesting things like, for instance, it won’t surprise
you but I think from the standpoint of your background, three years ago
things like the number of hospital patients per R.N. Or one of the
things that was interesting bubbled to the surface in my view was we
had asked about patient satisfaction information. You know healthcare
really publishes that out the wazoo! We found that consumers on a
day‑to‑day basis don’t even use it. What difference does it make to me
that you’ve got 92% patient satisfaction rate with your office waiting
time? They said to us, "Gee what I’d really be interested in are things
like references. You know you talk to the doc and you say to the doc,
"You want to take my gall bladder out? Could I have the names of two
people whose gall bladders you took out? I’d like to hear about their
experience."".So we actually introduced some new metrics such
as patient references available. Pain management programs’ was one that
tested really high. None of this information is in one place for
consumers but I have a particular interest in and a soapbox approach to
it. I really think palliative care and end of life and pain management
are significant infrastructure builds that we need to start paying
attention to for a number of different reasons as we look at how we
evolve and transform health care. Low and behold, pain management
programs for pain that’s chronic or after surgery or from cancer at end
of life tested really, really high. People never are given an option to
be able to understand what attributes in a hospital address those sorts
of relationship and experience issues, are evident and how are people
building them? So we really did get a whole different slant on things
just by listening to people.(Missing piece due to technical problems– read on—

Next Question is about the type of hospital quality indicators)

Mary Ann:
Yeah, yeah, Matthew they are. First of all there is the opportunity to
be able for instance in the hospital version of it, some of the key
procedures with the minimum standards a year. Then what the institution
actually does is part of them. So say coronary artery bypass or any
kind of abdominal aortic aneurysm repair is another one. Some of the
Leapfrog ones are actually in there. First of all the volumes are in
there. And the capability to be able to drill down and understand some
of the more individual provider procedure issues including things like
not just mortality rate, but infection rates. That’s also where pain
management and the nurse to patient ratio starts to become an ensemble
piece relative to that.Because it’s not just the number of
procedures or whether you live or die, but it’s the number that are
done by the particular provider, the numbers that are done by
particular institutions. What is the hospital patients per R.N.,
certainly if you are going to stay overnight or in the I.C.U. that’s
going to be important as well? So one of the things that we’ve tried to
do and again this is like starting from scratch relative to trying to
meet people where they’re at around this stuff is that when you click
on the particular metric you are also able to see a consumer data
definition on each of these and also, frequently a link to other sites
that give you that more detailed information as it evolves.But
there is also an element in the consumer data definition construct that
also not only what this measure is but also an element that says why
should I care? So that it starts to help people understand the why and
the what of it as well. But then if you think about again back to the
history with the nutrition label, when it started out people didn’t
know what trans‑fats were, or have any interest in any of that kind of
thing. What happened is that as consumers became a lot more
sophisticated about not only the role of nutrition but also the
implication of it in our day‑to‑day lives, then the nutrition label
changed accordingly.That’s exactly what we figure we’re going
to do as far as health care facts are concerned. I’ve represented it as
this Steamboat Willy. When they started with innovation you had to
start one place, but Steamboat Willy seemed like quite a significant
innovation at the time in the 1920s but if you look at Shrek today, it
looks a lot different, but it couldn’t have gotten too weird today of
it weren’t for the fact that we started with Steamboat Willy. So I sort
of think we’re the Steamboat Willy.

absolutely is the first step. The other thing is in some ways it’s
almost deceptively simple because one of the things that’s important is
in order to get comparative information, and the fact that you can
measure TulaneUniversity Hospital with the Mayo Clinic maybe is
illustrative of this. The one thing you’ve got to start with in
collecting the information is making sure everybody counts it the same
way. So the devil in the detail in this is really, really significant.
So that’s why the provider data definition issue is there, to ensure
that everybody is counting it in the same way.We paid a lot of
attention in the data description to minimizing the capability of even
looking at ambiguity in it. So for instance if you are looking at the
number of providers, and you were counting noses on the number of
providers, the definition describes that somebody first of all has to
be in practice at least 20 hours a week, so half time and that they
practice 51% of their time at that particular institution. So say for
instance the number of providers that are doing coronary artery bypass,
you don’t count how many times they are going different places; you
count where their home’ is. So there is a lot of devil in the details
relative to this counting component of it. That’s a real important
element that you don’t find in a lot of situations. It’s got to be an
attribute around the ability to be able to compare one to another.I
remember a bunch of years ago I did a cardiac centers of excellence
type of approach her in Minnesota and we had 13 different sites. And we
started out looking at quality measurement and quality improvement so
we could start to look at mortality and outcomes information. We were
measuring dead three different ways in just these 13 institutions. You
think about that. On the surface that seems relatively simple because
alive is dead. But we had people that were measuring it only as cardiac
related mortality. We had others that were measuring it cardiac related
30 days post‑discharge. It depends on how you define the data element
in terms of the meaningfulness and the ability to compare.So we
paid a lot of attention to make sure that there was integrity from the
standpoint of everybody entering their data exactly based on the same
definition so that there would be confidence that if you were looking
at Tulane University Hospital and the University of Minnesota, you were
counting it exactly the same way, like the nurse to patient ratio and
things like that. I think this is one of the things that folks don’t
necessarily understand when you start looking at like this work around
transparency is phases that you need to pay attention to. One is how do
you count? Counting is not necessarily easy if you’re going to do it in
a way in which there is comparability.The next generation
may be if we are going to move on to phase two, I also think we need to
keep in mind that we are counting what counts. That is a harder thing
to do because what counts isn’t always at least measurable at this
time. We have to start thinking about what the proxies are. From the
consumer’s perspective that’s a particularly important element to keep
in mind because they’re not going to, none of us are going to start
looking at stuff if it doesn’t mean anything to us. Counting what
counts from a consumer lens is a really, really important element of
this whole meaningful transparency journey that we’re on.The
third generation of questions that I almost even hesitate to talk
about, but at least it’s on my radar is, when you think about health
care at the end of the day it also is about relationship. It’s about a
lot more complicated things. Is what counts countable another element
that we need to be thinking about? But whenever I bring that up it
blows people away so I don’t say it very often. Hold that one for years
from now. OK.So one of the things that I actually did in
designing Health Care Facts from the get‑go on the hospital side was
take into account all of the elements of the IOM report. That includes
things like saying design from the consumer’s perspective. One of the
reasons why I have charity care in there quite frankly is the attribute
of social equity. So I wanted to be able to quantify that, the teaching
element in there because in any given situation if an institution went
away and they did a large amount of charity care or they were producing
the health professions for the 21st century, we need to somehow reflect
that in the value of what it is that’s their price point. So I really
paid a lot of attention to the IOM report and I think this is one of
the reasons why having a health care background and understanding how
we create the system for the 21st century, or having a desire to do
that was an important element of things.So then I went out with
a prototype and I started talking to CEOs. I got a couple of key
institutions within our market to say yeah, this is the kind of stuff
my Board is asking me for. These are different than the usual sort of
defeatist measures or things like that and there was also an
appreciation by several of the CEOs within our market that she’s
designing something from the consumer perspective in which you were
asking us to be part of from the get go. So this gets back to what I
think is a real important element to some of the things that need to
happen and that is that we really have to garner provider buy in as
demonstrated by their collaboration and participation.

I was going to ask you, the providers involved in this, what are they
going to have to do in terms of data submission. What’s the level of
pain on them?

Mary Ann:
Yes, yes, yes. The answer is yes. But not in different ways. What we
did is actually for the first thirteen providers that signed on board,
there were sort of two things in addition to being an early adopter of
this that we gave them the opportunity to help with the formation of
it. One is that we gave them the chance to help us define and come up
with the single data definition. So what we did was talk to them at the
provider side, how they were counting it. So for instance, we let
anything that they were doing that might be consistent with the joint
commission approach. We didn’t want to duplicate it work but we also
said you all have to measure it the same way so that standardization
opportunity was one that they had a chance to participate in and quite
frankly took advantage of. That was the first thing. The second thing
that we gave them the chance to do that I think was also a significant
carrot was that not only did they get a chance to look at their own
health care stats before it was released that they had a chance to look
at everybody else’s which was their competitors as well that they never
had a chance to look at side by side in a way in which they could
actually compare one versus another. So there was significant interest
in signing on board with that early on.The one squeamishness
that I got which was kind of an interesting one is that everybody–
although bear in mind this is like three years ago when we started the
hospital side–we actually wanted to give a quartile of prices. So
either we used a one dollar sign versus a four dollar sign. Now we’re
going to actual prices that three and four years ago that was a little
bit more squeamish type of demon that they would have to deal with. I
did frankly get some push back around, "well can’t we delay that a
bit?" We said well let’s wait and see and by the time that we got
through the process and we were ready for the 1.0 data release,
everybody was fine with their quartiles. So that turned out to be a

That’s interesting. Let me ask you a bit about the pricing, because
obviously Uwe Reinhardt among many others says hospital charge masters
were an act of fiction. When you talk about pricing are you talking
about the average rate that Blue Cross PPO pays them? When you say
pricing is that by procedures?

Mary Ann:
It was actually based on our (Blue Cross) contracted price. We also at
one point, now this was the initial release, it was also at one point
only based on inpatient, not outpatient as well because as you know the
way that we do pricing it’s very complex. There’s lots of moving parts
so we try to put some brackets around it. I got to tell you
what was interesting to me at the get go was, now here was the concept:
relative to how consumers shop and I’ll use another analogy, you know
Target, our home town team here, is sort of everyone would say that
was, I think that’s a one dollar sign. Neiman Marcus is a four‑dollar
sign. In our market we knew Mayo was the four‑dollar sign. Even when
you started calculating price it wouldn’t surprise you that they turned
out to be a four‑dollar sign. There were several others, actually many
other four‑dollar signs that didn’t necessarily stack up in the same
way that Mayo did. So it started a conversation around pricing based on
just sort of a primitive first step slice, that I think started getting
people to access where they were not only to their peers, but also how
they could represent value from the standpoint of those conversations.

Matthew:  Are
you now when I’m the consumer and I come on the site the moment I see
the dollar signs so I get the impression that this is a more expensive
versus a less expensive place. But are you going to replace that with
something that’s more tangible with price per episode, or how does that
work out?

Mary Ann:
What we’re doing right now if you go onto the site with the clinic it
doesn’t have the dollar sign there but if you’re a member, and this is
sort of the benefits of membership versus what’s available to the
general public, in the clinic we’ve actually started drilling down to,
so for instance if you want to know what the price of a new patient
might be if you have a cold and you want a work up on that or something
like that you can start to see not only what the price of that clinic
is but what the range of what that is. So maybe it’s eighty‑nine
dollars at that clinic and the range of the clinics in the database,
which is about 800 in Minnesota right now, the range might be from
sixty nine dollars to a hundred and nine dollars. So that’s available
for Blue Cross members only and we are working right now in a hospital
situation to do precisely that. Again it’s a benefit of membership as
opposed to available to the general public.

Now let’s talk a bit about how you’re going to take this principle. I
think what you’re doing is very interesting. Of course there’s a lot to
be said around if you can or cannot accurately price hospitals. There’s
also the issue about if you’re a member you’re getting the Blue Cross
rate and is that better or worst than the Aetna rate or the rate they
are charging the uninsured. There are a lot of issues around that which
we don’t have time to get into today. I guess the question is what
should you be pricing? Should you be pricing the individual procedures
for the office visit or should you be pricing the per month average
costs to be a diabetic taken care of by this clinic? There are some
other features in there we can go into. But I guess just to tilt this a
little bit, if consumer aware and healthcarefacts.org is now for
everybody, because you’ve gone for the market in Minnesota and
Louisiana and Nebraska, and one other I’ve forgotten or is it just

Mary Ann:  No, that’s it so far.

You’ve got those markets. Did you happen to have something special in
the water in Minnesota — everyone says there’s something special in
the water in Minnesota health care. It’s a bit of an oddity like
California. You’ve gone to some other places, Louisiana and Nebraska
are very different. Has there been a process in each one of those
markets to get this up and running? Or is it pretty much now the same
now that the outline is established that the health plans know that the
Blue plans are basically similar to other groups that you’ve got to
play ball here?

Mary Ann:
Oh, none of this has been based on any kind of a mandate or an
expectation around which you have to play ball. One thing, that I think
is absolutely intriguing, is that we have a Mississippi state link, I
think, with Minnesota and Louisiana. But we’re polar opposites, and I
think this is a good demonstration of how this is not just one of those
things that’s in the water in Minnesota. And one of the reasons why
Louisiana was intrigued by it was the fact that this did not require
any sort of a contracting change, what it really did was offer an
opportunity to be able to not only to talk to providers, to say, will
you join us voluntarily, but that we had also done it in Minnesota and
they came up and talked to our hospital association and said, what did
you think of this when you started, and why did you sign on‑board with
it?So I think it’s just a different way of doing things. And
another thing that was fascinating to me in our market was we talked to
the VA, I’ve done some work for their Robert Wood Johnson foundation,
and actually, quite frankly, I’m real intrigued by the whole VA model,
so I decided early on that I’d go over to the VA here and talk to the
head of that, just to get some feedback from them, because you know,
they have a great interest in patient safety and all that. And by
golly, the VA would participate in‑ they sent us fully filled‑out
healthcare facts, they’re on the database, and do the updates, even
though we don’t contract with them. So I think that under certain
circumstances, and I think with the right positioning, that there’s an
appeal and an intrigue about this, from the standpoint of offering an
opportunity to providers to describe themselves in ways that which will
be relevant to consumers in ways that aren’t just relevant to price, or
the usual kinds of things that are out there based on claims data.

That’s pretty interesting, so you’ve got, it sounds like good response
on the hospital side, can you compare that between the three states?
And the other question is, I get that big hospitals want to be viewed
on something other than price, this may be a big imposition for a
physician clinic, what kind of percentages are you getting for the
hospitals and physicians, between Louisiana and Minnesota?

Mary Ann:
Okay, we’ve got 100% of the hospitals, 100% of the large hospitals,
and 100% of the community hospitals. Now we have not worked on the
rural hospitals, for a number of reasons. We’ve decided that we will go
to primary care clinics next, before rural hospitals, but that does not
preclude a consumer from taking a blank “healthcarefacts” to a
provider, and saying, gee, will you fill this out for me? And then
you’d have a chance in which to‑ you know, you’ve got an existing
database in which you can do comparisons, and I think that would be an
interesting sort of mobilized consumers’ approach, because I know darn
well that if a provider has three consumers in that say, will you fill
this out, they’ll be calling us up and saying, I’d really like to get
on this database, since I’m getting bombarded with people asking me to
fill out this information. So I think it could catalyze it in that

Matthew:  If the consumer comes back to the same docs.[laughs]

Mary Ann:  Yes, that’s true, that’s true. But let’s be optimists here.

Matthew:  What’s your share inMinnesota now of primary care clinics, give me a sense, not down to a decimal point, but a general idea.

Mary Ann:
We have 100% of the primary care clinics for price. We have about 80%
of the primary care clinics on the database in the top list of quality
and price, and the rest of them are filling them out. We have over 840
clinics on the database, individual primary care clinics on the
database. I think that’s pretty remarkable.

Matthew:  What share of primary care in Minnesota do you think that is?

Mary Ann:
From the standpoint of admissions, I think it’s over 90% of the
patient visits. And it’s rural as well as Metro. Louisiana hasn’t
started on the clinics yet, only the hospitals, but they’re working on
the clinics right now. Now, we’ve only developed the template for the
clinics this year. The reason, quite frankly, why we started with
hospitals is the interesting thing about the hospital infrastructure is
that first of all, they don’t have offices of transparency. They’ve got
to find how to bolt this on somewhere. Because as you appropriately
identified, just getting this thing filled out and maintained takes
some work. And typically in the hospitals, people either went to their
quality improvement offices or they went to their patient safety
offices, and those were the ones that took the accountability for it.
Remember in clinics, if we’re going to start designing around
hospitals, there’s at least typically something that there seemed to be
a logical bolt‑on for transparency, and that was usually the patient
transparency office, or the quality improvement office. But in clinics
for the most part, this is not a function that they even have in there,
and especially in smaller clinics, in their infrastructure.So
the reason we really wanted to get started in hospitals was to get the
momentum going, figure out how to do it, and then end up starting to
work at how we would meet clinics. We actually did some different
webcasts, we did a lot of visits to clinics, to let them know what this
was, and how to get it going, and what the best approach might be in
order to get them not only to fill it out, but also to keep updating it
as well. We were pretty pragmatic about wanting to start out at
hospitals basically because the likelihood of getting the momentum
there was more significant. But I think I can see this as a skilled
nursing facility opportunity, a surgical center opportunity, we’ve got
some plans to do some having a baby healthcare facts, or a cardiac
healthcare facts, again this is the launch of something that is
directionally correct, we just need to evolve and learn as we go.

That all makes a lot of sense and seems to be working out for you and
let me ask you a few things about your future plans. The first one is,
this is‑ you are a subsidiary of the Blue Cross/Blue Shield of
Minnesota, but you’re an independent organization, considering that at
the moment you are funded by the Blue Cross/Blue Shield of Minnesota,
but I assume at some point somebody will want to make some money out of
this or give you some funding, what do you think the future business
model for this is, and how does it compare and contrast to other groups
of people who are doing various types of hospital rating and health
grades, and what is this noticeable of?

Mary Ann:
Folks have called us and wanted to know what we are doing as well. I
think a lot of other folks are really focusing more on the business
model side of things. Don’t get me wrong, that’s something we’re paying
a lot of attention to as well. One of our goals in setting this up as
part of the work that we’re doing through Blue Cross and Blue Shield of
Minnesota even though it’s in the consumer aware context is that it
wasn’t just about making the money. We have a strategic objective about
being a catalyst for positive health system transformation. So what
role do we play in that?

I think about the work that I’m doing not only in Minnesota but other
places, this is as much of a provider strategy as it is a consumer
strategy. We are still evolving what different scenario opportunities
there might be around business models. Absolutely we’ve got to think
about revenue models and we’ve got to think about distribution
channels. But we’re also focusing on the content as well. And I wish I
could answer that definitively for you. I can say that it’s what keeps
me awake at night as well but it is a work in progress. [Laughs](Technical snafu misses question here)

Mary Ann: OK
so we’ve had it up for about the first launch was on the hospital side
and it was about three years ago, two and a half years ago. So it’s
been around for a while. In many ways, what we needed to do was be able
to get content up there before letting consumers know it’s at this
point. I don’t know if you followed the Minute Clinic, the quick
clinic; they didn’t advertise or anything at first. It was word of
mouth and then people started using it. It expanded exponentially. So
one of the things that we are actually in the process of planning is a
lot more publicity. Actually we really appreciate the opportunity to be
able to talk to you because of this getting the word out now that we’ve
got all these primary care clinics, now that we’re getting momentum and
content as far as others are concerned.We do measure the number
of hits on the website. As a matter of fact I’ve got some recent
statistics that actually reflect how many hits we have based on also
compared to what’s going on. We buy Healthgrades and we buy Subimo. And
we are considerably ahead of the number of consumers that are looking
at it on MATT. That’s a metric that we collect month to month and it
averages about 3, 000 to 5, 000 a month which, I think for the fact
that we are still the best kept secret I don’t think is bad. I’m trying
to figure out what are the performance and success metrics that aren’t
just around the hit on the website. I think the fact that we’ve got
participation by 100% of the large providers including the VA and Mayo
who have never participated in public transparency efforts like this,
is a success metric.The fact that we were able to translate
this from Minnesota to Louisiana is a success metric — you know that
replicability type of thing. So that gets back to talking about what
can you count. We’re doing the usual counting relative to hits on the
website and the number of health plans that are signing up and what the
enrollment of those health plans is and the number of providers.But
also, are we counting what counts? We are trying to figure out what the
dashboard looks like in that context as well because in some ways I’ve
likened this to taking a pebble and throwing it into some water. You
watch the direction of the water go out in multiple different ways. So
this isn’t just a consumer strategy. This is a provider change of how
they view themselves and how they talk about themselves. This even
challenges the issue around is it about price or what is it that we
need to learn around what’s important to consumers beyond that price in
the context of other things. So it’s broader than just measuring it
linearly.Can I just mention one other thing though? One of the
reasons why we wanted to go with the single page in a nutrition label
is that it’s supported by a relational database. But I also think and
this is a really important concept from my perspective, is that even
when everybody changes and we raise the bar we go to Michael
Millenson’s vision around that, there is still going to be a best fit
in whatever circumstance that it’s going to be for individual people. I
still could imagine people sitting at their dining room table at night
and having printed eight different health care facts because they’re
trying to decide what the best fit might be for a particular procedure
or for their mother or dad having a hip surgery or something like that.Even
when we raise the bar relative to providers doing things differently I
still do think that the key to the kingdom around meaningful
transparency is going to be the opportunity for consumers to be able to
choose based on the attributes that are important to them in whatever
situation they are looking for, being it a healing relationship, being
it technical excellence or whatever. They are going to be able to
discriminatingly choose whatever the best fit might be based on the
information that ultimately will be available to them. That’s what my
vision would be.(technical Snafu) Question is about consumer generated content included in the siteMary Ann:
We’re already working on it. We’re working on another product called
Health Care Stories that is precisely that. So I see them as two sides
of the same coin. Know the facts. Know the story. Some people are going
to start with stories first. Others are going to start with the facts.
And at any given time you flip, because we’re quantum! We don’t always
do things in exactly the same way. We don’t fit in neat little boxes.
So absolutely, I see that as a dimension of it. Actually think that’s a
terrific dimension as well. And we’re working on that right now.

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  1. This looks like a good effort, and I hope it continues to expand. While I think consumers, with the right information, can make good choices about where to go for the lowest cost MRI or other diagnostic test or which local pharmacy has the best price for the prescriptions they need to fill, I think there is more bang for the buck to be had if doctors had good user friendly price and quality transparency tools and were incentivized by insurers to use them. If insurers made it clear to doctors that there is an interest in controlling utilization and steering patients to the most cost-effective providers for services, tests, procedures, and drugs they need, I think doctors will respond if there are proper incentives and sanctions in place as well as accurate, easy to use price and quality information at their disposal.

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