Transforming Care Through Transparency

By year’s end, the Department of Health and Human Services will announce plans for making its Physician Compare website into a consumer-friendly source of information for Medicare patients about the quality of care provided by doctors and other health care providers. In doing so, Physician Compare will take its place alongside Hospital Compare and more than 250 other websites that offer information about the quality and cost of health care. More importantly, perhaps, it will send an important signal that transparency in health care is the new normal.

To look at these 250-plus online reports is to see the good, the bad, and the ugly of the public reporting aspect of the transparency movement. Some make it easy for people to make choices among physicians and hospitals, and just as notably, let providers see where they fall short and need to improve care. But others ask too much, forcing users to sort through rows and rows of eye-glazing data and jargon that requires a medical degree to fathom.

The Affordable Care Act calls for Physician Compare to offer information about the quality of care, including what physicians and their practices did and the outcome for patients, as well as care coordination; efficiency and resource use; patient experience and engagement; and safety, effectiveness, and timeliness. That’s a lot of information, and it demonstrates the tall order facing the federal government to make the reports meaningful and accessible, so that physicians and patients will both be more apt to use them.

This is critical. Everyone—consumers, doctors, hospitals, employers, health plans, policy-makers—needs information about the quality and cost of care. Consumers need this information to make informed choices about doctors and hospitals, just as they would for other major purchases and decisions. Doctors and hospitals can routinely use the information, as some already are, to improve their performance. And purchasers need the information to determine the value they are getting for the dollars they spend.

Aligning Forces For Quality

This kind of transparency is at the heart of the Robert Wood Johnson Foundation’s signature quality effort, a program called Aligning Forces for Quality (AF4Q). The initiative is at work in 16 markets around the country, some as small as Humboldt County, California, and some encompassing entire states like Maine and Oregon. In each, there are public reports on the quality—and, in some cases, the cost—of health care in the community.

This summer, our new partnership with Consumer Reports also spurred its first-ever report on patients’ experience of care across physician practices, letting people see how well doctors and their practices provide important information from the patient’s perspective, including how well physicians communicate with their patients, coordinate medical care, and whether patients would be willing to recommend their doctor to family and friends. This first report rolled out in Massachusetts, building on previous reports issued by Massachusetts Health Quality Partners and AF4Q. A second report was also recently released in Minnesota with MN Community Measurement, which had a focus on quality of care provided to patients with diabetes, cardiovascular disease, or both. And Consumer Reports will release another report next year in partnership with the Wisconsin Collaborative for Healthcare Quality, the AF4Q alliance in Wisconsin.

Lessons Learned

Through our work, we have learned that we can engage physicians and patients alike to use these reports to improve the quality of care they give and receive. But we have also learned that it is not easy.

We learned, for example, that it is important to involve doctors in the report’s design and methodology from the get-go; otherwise, physicians will be less likely to see the value of the data and less willing to share reports internally within their practices. So, it has been commonplace among the AF4Q alliances to develop private reports that allow physicians, medical group administrators, and clinic managers to review the data for accuracy before it is shared publicly. Physician acceptance is critical to make sure the information is used as a baseline for improving care.

When they do, good things can happen. Recent studies on the Wisconsin alliance’s reporting efforts saw that participating providers outperformed non-member peers in Wisconsin, nearby states, and the rest of the United States, and that participating Wisconsin clinics were more likely to implement quality improvement programs.

Similarly, public reporting spurred the Ellsworth Medical Clinic in Ellsworth, Wisconsin, to involve its entire staff in providing better care. After learning only 47 percent of the clinic’s patients received the recommended care for vascular disease, the clinic empowered its lab technicians to check for missing tests, receptionists to contact patients about needed visits or screenings, and care coordinators to follow up with patients. The next year, 68 percent of patients received optimal vascular care, a 20 percent improvement and the highest rating compared to 433 other clinics in the region.
AF4Q alliances’ reports are not perfect, and we are working hard to help them do a better job. The alliances have designed—and redesigned—their public reports to include clear, actionable information on quality and cost that matter to both consumers and providers. The way you display and explain the data is just as important, if not more, than what the data shows. For instance, designing a report using tools like mapping and a combination of words and symbols can make it easier for consumers to see which practices nearby deliver the best care.

It’s also crucial to tell people about the reports at times when they are most likely to want and use information on the quality of care: when they move, their insurance changes, or during open enrollment season; when their health status or their diagnosis changes; or when they have a problem or issue with their current physician.

We’ve come a long way, and learned a lot. But it is also is clear that we have a long way to go. The lessons we’ve learned can be seen in this brief report, which touch on some of the most important aspects of creating a quality report: engaging physicians and other stakeholders, using reports to spur quality improvement, selecting the right measures, and making reports consumer-friendly.

We know that transparency is not a panacea. And no, we don’t think that people having a heart attack will quickly navigate over to a website and choose a hospital from the back of an ambulance. But we do know that public information can inspire providers and purchasers to change their behavior. We also know that the health care system won’t be transformed through medical homes or accountable care organizations alone.

We have to change what it means to be a patient and consumer of health care. Making information about the quality and cost of care ubiquitous, and a routine part of the way we consume health care, can help us get there.

Anne F. Weiss, MPP, is a senior program officer at the Robert Wood Johnson Foundation and directs the Foundation’s Quality/Equality Health Care team.

Anne Weiss, “Transforming Care Through Transparency”, Health Affairs Blog. October 5, 2012. http://healthaffairs.org/blog/2012/10/05/transforming-care-through-transparency/

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