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 presenters 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 Presenters