Focusing consumers' attention on quality when choosing healthcare benefits is a bigger initiative than ever for this year's open enrollment period, under way in human resources departments across the country.
Health plans, hospitals and health systems are announcing their accreditations and awards. Even some medical groups are willing to have their quality assessments compared and contrasted. Employers have long been the targets of quality marketing efforts, and traditionally they have taken on the job of disseminating information on plans' standings to their employees.
This fall, one accrediting body is going directly to the patients with quality assessments for health plans, and a federal agency is taking steps to do the same soon.
The National Committee for Quality Assurance in October launched its "Choose Quality" campaign, the cornerstone of which is a new Web site (www.healthchoices.org) that lets consumers access report cards for all health plans offered in their state or around their ZIP code. The effort is a relatively new approach, says NCQA spokesperson Brian Schilling, adding that while employers have been involved in calling for better quality for about a decade, the direct-to-consumer approach is just now gaining momentum.
"We get 50,000 hits per month now," Schilling says of patient hits on NCQA's regular Web site. "We want to increase that, obviously." He says engaged consumers will create a groundswell of support for quality initiatives that will give health plans incentive to improve their standards. "The consumer needs a lot of information to make smart choices."
NCQA also offers employers an open enrollment toolkit to pass on to employees, as well as using tried-and-true media exposure, to get the message out, Schilling says.
Meanwhile, the Agency for Healthcare Research and Quality has updated its consumer publication, Your Guide to Choosing Quality Health Care, and will launch www.TalkingQuality.gov later this year, says Katherine Crosson, a project officer for the agency's Consumer Assessment of Health Plans (CAHPS) program.
The new site is designed to position the CAHPS measures as a quality resource that offers patients an alternative to cost as a determining factor in choice of plans, Crosson says.
These sentiments echo those of Thomas Collins, CEO of the Long Beach, Calif.-based MemorialCare health system. In a commodity-driven market focused almost exclusively on cost, MemorialCare began taking quality initiatives directly to the consumer as far back as 1996, Collins says.
That year, the five-hospital system gathered 35 of its doctors and started building clinical protocols in several specialty areas. The protocols were based on best-practice indicators from a variety of sources that the doctors decided to use or not use based on their own experiences with them, Collins says. To get the doctors involved in the effort, he says, "I told them, 'I will gather the data and speak to the communities we serve . . . and I will link your identity to the clinical protocols."'
MemorialCare, which doesn't own any physician practices and has no employee doctors, links outcomes to 1,041 individual doctors who are all fee-for-service.
Skeptics told him "you'll never get past price," he says. But the effort to focus on quality paid off-perhaps, Collins says, because the emergence of the informed consumer occurred at about the same time. To get the word out, MemorialCare uses the Internet, its hospitals' intranet, quarterly reports from the system's board of directors' clinical committee and an annual report to the community, now in its fourth year, produced in partnership with a local television station.
Besides attracting customers--the patient base has increased 30% over the past five years, Collins says--the approach also has attracted more doctors, who are saying "this is what we want in a hospital-physician relationship."
Getting information to consumers is one thing, but getting consumers to act on that information is something else, say both Collins and Christine Crofton, another AHRQ project officer working on CAHPS. Much of what Collins has seen involves charts of all types that patients don't tend to take the time to interpret. Crofton says even some of AHRQ's literature for consumers ended up being pages too long to hold their interest.
"It's a sticky area," Crofton says. "How do you put information out there and have navigating cues (for consumers to follow) to make it useful?"