Since the
mid-eighties, health policy experts have advised corporate healthcare
purchasers to consider both cost and quality-of-care data when
purchasing healthcare. Feeding the demand for transparency in cost and
quality reporting is consumers' expectation to find reliable quality
and comparative performance data on provider Web sites to support them
in their healthcare decisions. Additionally, many payors are reducing
reimbursements for sub-par provider performances accordingly.
Providers and
health plans are scrambling to comply, but C-suite pushback, technology
obstacles and the overwhelming hope that a set of consistent and
reliable performance and quality measures to post will be developed is
delaying some initiatives.
In "Toward
Transparency in Healthcare: Competing for Quality and Consumers," a
panel of experts discusses the challenges of incorporating public
reporting as part of an integrated strategy, collaborating with
providers, and developing objective metrics and reliable data.
With consumers
just a mouse click away from choosing another physician or hospital,
healthcare organizations must find a way to drive quality through
effective public reporting or face a possible loss of business. In this
special report, HIN's accomplished panel of contributing authors
furnish details on the following:
- Furthering
the transparency agenda with healthcare report cards;
- Responding
to data validity and reliability issues;
- Evaluating
internal vs. external reporting mechanisms;
- Communicating
quality and performance data to employees, patients and members; and
- Building a
quality-based specialty provider network.
Throughout
this 46-page report, these respected thought leaders describe their
experiences in the healthcare data reporting arena:
- Paul
L. Green, director, clinical quality improvement, John F.
Kennedy Memorial Hospital;
- Christine
Profita Orok, project leader of cost and quality at Blue
Cross Blue Shield of Massachusetts;
- Paul
Thompson, product development director with Cigna Healthcare
This report is
based on 2005 and 2006 audio conferences on the emergence of
transparency in healthcare cost and quality as an industry hot button,
as well as the more than 300 responses to HIN's 2006 e-survey, "The
Role of Healthcare Report Cards."
Table
of Contents
- Healthcare
Report Cards: Origins, Audience and Utilization
- Hospital
Reaction to Public Scrutiny
- Quality
Data Does Influence Consumer Choice
- Trends
in Hospital and Physician Pay for Performance
- Socializing
the Internal Report Card
- External
Report Cards: The Public Picture
- Physician-Specific
Reporting and Related Cost Factors
- Healthcare
Competition: Local, National, Global
- Winning
Strategies for Effective Reporting of Data
- Grading
Healthcare Report Cards and Their Impact on Care and Cost
- Validity,
Reliability Key Concerns
- Facilitating
Data Gathering
- Some
Positive Impact
- Alternate
Communication Channels
- Consumers
Provide Feedback
- Case Study:
BCBS - Massachusetts Public Reporting Part of Multi-Tiered Strategy
- Goals
for Public Reporting
- PCP
Incentive Program
- Posting
Public Reporting Data
- Viewing
Physician’s Quality Data
- Engaging
Multiple Communities with Program Promotion
- Case Study:
Cigna Healthcare Builds Quality- and Performance-Oriented Specialty
Provider Network
- Rationale
for Specialty Choices
- Associated
Challenges of Program Rollout
- Process
for Quality and Efficiency Selection
- Performance
Indexing
- The Use
of Evidence-Based Measures
- Q&A:
Ask the Experts
- Using
Provider Directories Vs. Third-Party Vendors to Post Information
- Presenting
Cost Information
- Program
Initiatives for the Consumer
- Thresholds
That Reward Provider Progress
- Financial
Incentives for PCPs
- Generic
Prescription Use Rates
- Assessing
e-Technology Components
- Validating
External Report Cards
- Internal
Impact of External Report Cards
- Quantifying
Member Access of Physician Quality Data
- Addressing
Invalid Benchmarking Data
- Overcoming
the Challenges of Public Data Reporting
- Extending
Reporting to Specialists in Hospitals
- What’s
Ahead in Public Data Reporting
- Online
Placement of Quality Ratings
- Pursuading
Providers to Share Charge Information
- Tradeoffs
in Transparency
- Aligning
Contracting Strategy with Transparency Goals
- Integrating
Transparency Data with Out-of-Pocket Costs
- Adding
Evidence-Based Measures
- Glossary
- For More
Information
- About the
Authors
