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December 27, 2012

Creating More Savvy Consumers Through Public Reporting

by Mary E. Vaiana

As Nobel laureate Kenneth Arrow famously observed, health care doesn't behave like a normal market in which both buyers and sellers have the information they need to make a decision. In the health care market, sellers (physicians, hospitals, health plans) have the advantage because they usually know far more about the product (medical care) than buyers (patients) do. So consumers have played a limited role in the market.

However, there is one dimension of health care about which only consumers have accurate information: their own experiences with care. Only patients know whether their pain was adequately controlled in the hospital. Patients can observe and reliably report whether health care providers communicated clearly with them, whether they experienced long waiting times, or whether they were treated respectfully. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) family of surveys is designed to capture these and similar observations in a systematic way that facilitates reporting the results publicly to help other consumers make care decisions. The assumption is that reporting consumer experiences can shape the market by helping other consumers make more savvy decisions. In addition, consumer choices may influence providers and purchasers to improve the care they offer so that they can effectively compete in the market.

The initial CAHPS survey, funded by the Agency for Healthcare Research and Quality in 1995, focused solely on health plans, but over the last decade, health-plan CAHPS has grown into a family of surveys, tapping patient experiences in multiple settings. As of September 2012, the surveys included individual clinicians, surgical care, mental health, dental care, home health care, nursing homes, hospitals, and end-stage renal disease. Surveys for accountable care organizations, emergency departments, hospice care, prescription drug plans, and outpatient surgical centers, among others, are being developed.

CAHPS products (e.g., surveys, reporting formats, quality improvement tools, and research studies) have been produced by teams from the American Institutes for Research, Harvard Medical School, the RAND Corporation, Research Triangle Institute, and the Yale School of Public Health. CAHPS surveys are widely used by the Centers for Medicare and Medicaid Services (CMS), and health plans are required to report CAHPS data as part of maintaining their accreditation. Because CAHPS survey results are publicly reported, they are available to anyone who wants to use them.

A new special issue of Medical Care highlights the range of CAHPS contributions. For example, topics include: how patient experiences of care are affected by health information technology, cultural competence of hospital staff, experiences with Medicare Part D prescription drug coverage among people of different races/ethnicities, and the nursing home experience from the family perspective.

An important tool for reporting CAHPS results is the CMS Plan Finder website, used not only by individual consumers but by counselors who help the elderly make decisions about choosing plans. The site contains a wealth of information, but human beings have limited processing capacity. Multiple studies have shown that consumers may find public reports overwhelming, which can make decisionmaking more difficult rather than supporting it. Aware of such concerns, CMS has been testing the Plan Finder website with users since it was established, and recently asked RAND to develop and test potential enhancements to the site. The overarching goal of this effort, which is currently underway, is to support consumer decisionmaking by presenting CAHPS information in a way that makes it easier to compare options.

Chris Crofton, a CAHPS project officer since its inception 17 years ago, describes the value of CAHPS from an additional perspective: "CAHPS data reflect the specific experiences of individual patients. Organizations that collect and publish CAHPS data offer patients valid and reliable information on which to base their health care decisions, such as which doctor or health plan to choose. But just as important, CAHPS data also identify areas where providers and organizations can improve their services. Ultimately, the latter may have the most lasting effect on health care delivery."


Mary E. Vaiana is a communications analyst at the nonprofit, nonpartisan RAND Corporation.