Effectiveness Data and Information Set (HEDIS) for health plans to the Centers for Medicare & Medicaid Services’ (CMS’) initiatives on comparing the quality of hospitals and health care providers (Friedberg and Damberg, 2012; NCQA, 2011; O’Neil et al., 2010).
Public reporting has been correlated with improved performance on those measures reported and has encouraged organizations to undertake improvement activities (Hafner et al., 2011; Hibbard et al., 2003, 2005a). For instance, the Joint Commission found that compliance with best practices, such as the administration and discontinuation of prophylactic antibiotics for selected surgical patients, increased dramatically after the metric was publicly reported (Chassin et al., 2010); the rates of compliance with the Joint Commission’s pneumonia care composite metric rose from 72 percent to 95 percent in 8 years (Joint Commission, 2011). Similarly, after CMS released measurements of the quality of heart attack care, improvements such as lower mortality, reduced lengths of stay, and reduced readmissions soon followed (Werner and Bradlow, 2006, 2010). Based on these and related successes, many health care opinion leaders believe increased transparency is an important factor in improving the overall performance of the health care system (Stremikis et al., 2010).
One channel through which transparency can improve health care quality and value is by affecting the selection of providers and health care organizations. In every community, hospitals and physician practices are delivering both high- and low-value care. Patients, however, are not equipped with the tools needed to identify organizations that provide high-quality, high-value care. The public often has more information when making decisions about purchasing consumer goods, such as refrigerators or televisions, than when making decisions about health care.
An aim of public reporting and improved transparency is to remedy this lack of information. By drawing attention to high-value providers and organizations, public reporting can affect the number of patients who choose to visit a given clinician or health care organization, thereby providing a business case for improving value (IOM, 2006, 2010a; Werner et al., 2010). One tool for drawing additional attention to high-value providers and organizations is the use of tiered benefit plans, which have lower patient cost sharing for those providers deemed to be of higher quality (an example is described in Box 8-2). By coupling reporting with financial incentives, these types of plans may drive greater patient volume to providers and organizations that offer higher-value care. Such benefit structures highlight the need for accurate measurement of care value.
Today, however, few consumers use publicly reported information to make decisions about clinicians or health care organizations; a 2008 survey found that only 14 percent of respondents had seen and used comparative quality information about health plans, clinicians, or health care