Creating Change Locally: Challenges and Opportunities of Public Reporting

1. Creating Change Locally:Challenges and Opportunities of Public Reporting Dale Shaller, MPA Leader, Yale CAHPS Reports Team Managing Director, National CAHPS Database Iowa Health Buyers Alliance October 15, 2008

2. Two Major Behavior Change Goals of Public Reporting • Consumer and Patient Behavior • Motivate and enable informed choice of high performing health plans and providers • Provider and Plan Behavior • Motivate and enable performance improvement in areas that are made transparent

3. Consumer Choice: How are We Doing? • Explosive growth in public reports aimed at consumers • Federal level • State agencies • Community coalitions • Health plans • Entrepreneurs • Limited evaluation and evidence of impact

4. RAND Systematic Review • Review of 45 studies since 1986 • What is the impact of public reporting on consumer choice, quality improvement, and clinical outcomes? • Findings on consumer choice: • Health plans (n=8): modest effects • Hospitals (n=9): inconsistent effects • Individual providers (n=7): inconsistent effects Fung, CH, et al. Systematic Review: The Evidence That Publishing Patient Care Performance Data Improves Quality of Care. Annals of Internal Medicine 2008; 148:111-123.

6. Consumer Choice: What’s the Problem? • Reports are too complex • Needed information is scattered • Few resources are devoted to promotion • Different reports convey conflicting information • Meaningful choices may not exist Shaller D. Consumers in Health Care: The Burden of Choice. California HealthCare Foundation: October 2004. (www.chcf.org)

7. Example of the Problem

8. Consumer Choice: Opportunities • Simplify report design • Bring needed content together in one place and summarize it • Strengthen marketing savvy and engagement efforts • Segment and target consumers making choices • Create financial incentives for choice • Coordinate with multiple report sponsors • Build evaluation science into reporting initiatives so we know what works and what doesn’t!

9. Example of the Opportunity

11. Resources for supporting consumer choice reporting www.talkingquality.gov Report Card Compendium

12. Motivating Performance Improvement: How are We Doing? • RAND systematic review findings: • Plans and providers (n=0): no evidence • Hospital improvement (n=11): positive effects • Clinical outcomes (n=11): inconsistent effects • NCQA: Plans that publicly report consistently achieve measurable improvements • 1 in 3 Americans now enrolled in an “accountable” health plan • 2008: Commercial plans show improvement on 44 of 54 clinical measures

13. Hibbard Study of Impact of Public Reporting in Wisconsin Hospitals Percentage of hospitals with poor scores at baseline that improved their scores after public reporting

14. Motivating Performance Improvement: Opportunities • Align financial incentives for improvement • CMS/Premier demonstration of P4P • Tiered networks • Coordinate with multiple report sponsors and payers • Create tools and capacity for improving • Build evaluation science into improvement initiatives so we know what works and what doesn’t!

15. CMS/Premier HQID Results

16. Concluding Thoughts • Previous reporting strategies have not worked so well in changing consumer behavior • We need a new approach to reporting grounded in decision science, social marketing, and evaluation research • Both consumer and provider response to public reports can likely be enhanced by aligning metrics and incentives • If we get it right, individual consumers and the system as a whole will be better off