The Commonwealth Fund Blog

Transparency and Consumer Education Needed for Health Reform Success

October 25, 2010

Tags: health care quality transparency in price and quality

Barbra RabsonBy Barbra G. Rabson, M.P.H., Executive Director, Massachusetts Health Quality Partners 

If we want high-quality, high-value health care in this country, we need to share information about what is happening inside our health care system with everyone who gets, gives or pays for care. For the past 12 years, I have had the privilege of working towards this transparency as the executive director of Massachusetts Health Quality Partners (MHQP), a leading regional collaborative focused on providing trusted and transparent performance information to physicians, patients and payers.

MHQP provides physicians with information to help them identify areas for quality improvement, evaluate the results of those efforts and compare their performance with others. One of our goals is to reduce variation in performance among medical groups. For some of the key measures of care MHQP has been tracking, variation has narrowed as the lowest scoring groups have improved. For instance, three years ago at the best medical groups, 100 percent of cardiovascular patients received a cholesterol screening within one year of being discharged from the hospital. At other groups, only 72 percent of patients received the screening. Now, all medical groups administer the screening to at least 83 percent of patients, which means variation statewide decreased by 11 percentage points in just three years.

Our statewide rates for other performance measures have also improved. The number of patients with cardiovascular conditions who met their target for cholesterol management (good results from a serum cholesterol LDL-C test) improved from 61 to 68 percent, and cholesterol management of patients with diabetes improved from 47 to 54 percent. During the last six years, annual chlamydia screening has risen from 41 to 57 percent of patients, and well child visits for adolescents and babies have risen from 67 to 74 percent and 90 to 96 percent, respectively.

These figures showcase the difference that performance reporting can make on improving quality in a relatively short period of time. Many of these successes are shared by other regional collaboratives across the country that, like MHQP, are part of the Robert Wood Johnson Foundation's Aligning Forces for Quality (AF4Q), the U.S. Agency for Healthcare Research and Quality's Chartered Value Exchange (CVE) or the Network for Regional Healthcare Improvement (NRHI).

For patients, MHQP offers public reports that can help them make better decisions about the care they receive. However, reaching consumers with the right messages has proven to be a challenge. Though we continue to make strides, our successes with patients are not as quantifiable as with physician quality improvement efforts.

One lesson from our efforts to share comparative performance information with patients is that patients don't necessarily have the tools to evaluate good care and make informed choices. To address this, along with information about patients' experiences of care, MHQP is unveiling an Expect the Best campaign to educate patients about what they should expect from office visits with their primary care physicians so they can better evaluate their care. For example, the program will tell patients that when your doctor orders a test, such as a blood test or x-ray, you should expect your doctor's office to follow-up with the test results. You should expect your doctor to take the time to give you clear instructions on how to take care of your medical problem, including what to do if your symptoms get worse or come back. By educating patients on what they should expect from their medical experience, we will empower them to become advocates for themselves. We will teach them to insist on quality care.

We have also learned from the work of the Partnership for Healthcare Excellence that simple messages work best for patients. Easy-to-remember phrases such as "good patients ask questions" and "keep a medication list" are more likely to stick than the explanation of a complex concept like health care quality. We will apply these lessons as we continue to share transparent quality information with consumers.

We have begun to focus on providing comparative pricing and cost information to consumers, but this is a more difficult challenge than it may seem. Consumers are used to the idea that the greater the expense, the better the product. Whether you are talking about hotel ratings, a bottle of wine or knee surgery, consumers link higher cost to better quality. Research has shown that more services and higher spending do not always result in better outcomes—and sometimes, they result in worse ones1. But patients have difficulty accepting that more care--and more expensive care--is not necessarily better care.

That's why we need to do a better job of creating messages that resonate with consumers. This requires collaboration on the part of patients, providers, employers, health plans and government agencies. For example, to reduce the overuse of antibiotics, we need to share comparative information with physicians about their performance, but we also need to educate patients about the personal and community harm of overusing antibiotics. We will not be able to reduce costly, unnecessary care in our health care system unless we work together.

Combining transparency with consistent, simple messages about high quality care will bring us closer to a more informed and discerning public. By making performance and cost information transparent to those who get, give, and pay for care, MHQP and other regional collaboratives across the country are helping health reform to succeed.

This blog post is a commentary on Health Care Opinion Leaders’ Views on Transparency and Pricing .


1 Fisher ES, Wennberg DE, Stukel TA, et al. "The Implications of Regional Variations in Medicare Spending. Part 1 and Part 2." Annals of Internal Medicine, 138(4): 273:298, 2003.