Measuring the quality and value of health care delivered to patients, and reporting that information publicly, lies at the heart of performance improvement. After all, to deliver better care, health care providers must first understand how their performance stacks up against their peers. Besides motivating providers to improve, publicly available performance data can be used by health plans to reward quality and by patients to make more informed care choices. With Commonwealth Fund support, Massachusetts Health Quality Partners (MHQP)—a coalition of physicians, hospitals, health plans, purchasers, consumers, and government agencies)—is working to develop measures, collect data, and publish reports. We talked to MHQP executive director Barbra Rabson, M.P.H., about the challenges involved in evaluating and reporting on the care experience.
How can publicly reporting data about physicians or physician groups help improve the quality of health care delivered?
Barbra Rabson: Public reporting of performance information is a huge motivator for clinicians to improve. Doctors are very competitive folks. In our first public release in 2005, we compared nine physician networks across the state. Partners HealthCare came in second, and it wasn't used to being number two. Overall, Harvard Vanguard ranked first; it's an old staff-model HMO with centralized systems and information technology. Partners had been looking to design its health information records, but when the report came out and Partners saw Vanguard's performance, it decided to budget differently and implement a centralized system [like Vanguard's]. If that information had not been public, Partners couldn't have acted on it.
Another example: there was a small group that wasn't large enough to be included, but when the saw report came out, it saw the writing on the wall in terms of how high the bar was set. It decided to take a big leap and implement electronic health records years earlier than originally planned—to get from where it was operating to the benchmark level.
In addition to measures of provider quality, you're reporting on patients' health care experiences. Why are they important?
Rabson: Research shows there is a tie between patient compliance with their medical regimen and good communication with physicians. It's common sense. If you relate to your physician, you are more apt to do what he or she says. If you have a bad experience, you tend not to go as often or, if you have a terrible experience, you may never go back. Measuring patient experience is one of the few ways we can determine whether care is patient-centered—a key feature to a successful health care system and an area where we often do not excel.
One important finding we discovered from our patient survey was that patients rate their personal physician higher than they rate the care team. This is a problem. We have so few primary care physicians and are moving toward a care team model. While patients may have to accept this new model, practices really have to do a better job of making sure the team is acceptable—introducing members of the team to patients, making sure they have access to the same information that the primary care doctor does. Unless you survey patients, you would never discover a finding like that.
How have providers reacted to the reports you've published so far?
Rabson: On the clinical side, physicians have really embraced this information. MHQP is a trusted source of information for them and the only state source of performance information—there are no competing reports. In addition, we have a collaborative approach. Physicians are at the table, helping make decisions about measures, methodology, reporting, benchmarks. That helps a lot. Many medical groups use our data internally for pay-for-performance programs within their practices. When we had some delays this year, we kept getting calls asking, "When are the data coming? We need these data."
You're now exploring the possibility of reporting measures of resource use. What has been the reaction to this step?
Rabson: What we've found from doctors is that they want accurate, usable information. They really accept there's a need to start to measure value. They want to make sure that when they get feedback, it's not just punitive—'you're inefficient, you're a 1.3.' It's not fair to measure people and say, 'you didn't do well,' and then not tell them how to improve. They want to know how they're doing and how others are doing, and things they can do to change their practice and become more efficient.
We're also going to be running focus groups with consumers about their views. One recommendation we've heard is not to use the word "efficiency." When patients hear that, they think that someone is trying to limit the amount of care they can get, as opposed to the idea that overutilizing services is really bad for you.
What is the next step for MHQP?
Rabson: From the focus groups, we found that individual doctors want their own data. In the past, we've sent group-level data to the medical directors and many then send it on to the individuals. But it's probably a good idea for MHQP to send the information directly to individual physicians, so they have personal performance feedback. That would give them the opportunity to act on the data. We've also heard that physicians would like to know what the benchmark performers are doing to get where they are. We don't have that information at our fingertips; it's something we need to delve into.
Another area is understanding consumers more and achieving a better understanding of how to engage them to take charge of their own care. Here in Massachusetts we're in the middle of health reform, and we have a lot of people who have never had health insurance before who are now choosing doctors. We have an important role to play in providing information to them.