Provide Intermediaries To Help Consumers Use Quality Information

Many Americans do not like to make decisions based on what they see in writing from someone they don't know. They want to get information and recommendations from someone they know and trust. National surveys conducted since 1996 have consistently found that consumers are most likely to rely on the advice of their doctors, friends, and family when choosing health plans and providers.¹

Surveys have also found that consumers rely on and have confidence in information provided by personal providers, family, friends and neighbors, and leaders of faith-based organizations and community groups.²

While a report card sponsor cannot replace a trusted friend or relative, one critical resource you may be able to provide is access to an informed individual who can answer users' questions, address their concerns, and help them apply information on health care quality to their personal situations. In addition to providing a more personal interpretation, this "information intermediary" can help legitimize the value and accuracy of the report, clarify things that are confusing, and support people in applying the information in their own lives. This approach takes time and resources, but it has great potential, especially if your audience is hard to reach.

Learn more about supporting patients' choices in: Martino SC, Grob R, Davis S, et al. Choosing doctors wisely: can assisted choice enhance patients' selection of clinicians? Med Care Res Rev. 2017 Nov 25. doi: 10.1177/1077558717743822. [Epub ahead of print]

Identifying and Recruiting Information Intermediaries

For most report sponsors, the involvement of information intermediaries is a new strategy. The best intermediaries tend to be the staff of organizations your audience already knows and trusts, such as faith-based organizations, social services agencies, family advisors, benefits specialists, and people who serve or advocate on behalf of specific groups of consumers defined by age, geography, culture, or health condition. For guidance on identifying, recruiting, and engaging consumer advocates in a quality reporting project, read The Community Quality Collaborative Leader's Guide to Engaging Consumer Advocates.

Use the following criteria to assess the feasibility and appropriateness of an organization to serve as an information intermediary:

• Your audience views the organization as a credible source of help with health-related problems.
• Staff are willing and able to get training on your report and on how to help people use it to be effective.
• Staff are willing and able to be neutral about the choices made by those they help.
• Staff are committed to the privacy and confidentiality of any information given to them by the people they help.
• Staff have the time and resources (e.g., space) to provide this assistance to a reasonable number of people.

What You Can Offer Intermediaries

Many if not all of the groups and agencies that are in the best position to serve as information intermediaries have other priorities and scarce resources. They can’t take on complex new responsibilities without some kind of benefit to themselves. Typically, they are already trying very hard to respond to a wide range of needs. You are asking them to respond to yet another. In an ideal world, these groups could get financial compensation for the help they provide, but most report sponsors do not have the funds to do this. What sponsors can do is identify other benefits they can offer to potential intermediaries to get and keep them interested in supporting consumers in using quality information.

• Can your staff help them with anything in return?
• Can you help connect them to people or information that are important to them?
• What kind of recognition will matter to them?

If you have limited experience with this kind of group, find others who are more experienced and get their advice. Another strategy is to set up meetings with a variety of agencies, or even a group meeting with several agencies, to find out how they think they can (and cannot) help you and what they think you may have to offer to them.

What Information Intermediaries Can and Can't Do

Intermediaries can provide a wide range of support to report sponsors, both by helping people use the report and helping to promote and disseminate the report.

• Learn how intermediaries can help with distribution in Channels: Reaching Your Audience in a Setting.
• Learn how intermediaries can help with promotion in Using Classic Outreach Strategies To Add the Personal Touch.

Possible Roles for Intermediaries

The table below provides an overview of all the tasks intermediaries might perform. Note that the tasks get more complex as you move down the list.

What Not To Do

• Do not ask intermediaries to do more than they are comfortable doing. For example, some intermediaries might not be willing to make recommendations for users of your report.
• Discourage intermediaries from making decisions for a consumer. This kind of situation can be tricky because people often ask intermediaries to make their decision for them or to confirm the decision they have reached. Being able to deal with this situation effectively when it arises is one reason why training is so important.

Training Information Intermediaries

The people who will serve as information intermediaries must be equipped with the skills and knowledge they need to do the job. If they aren't associated with healthcare organizations, many intermediaries, especially volunteers, may be no more familiar with health care and quality issues than the people they serve. The report sponsor must help them understand the meaning and value of the data and feel positive about how they can use the information to help their constituents.

Training Tips

• Train them to talk about the issue of healthcare quality, understand and interpret the information in your report, and guide consumers through the decisionmaking process.
• Provide them with scripts or talking points that focus on common issues, as well as consumer-oriented brochures and other documents they can pass on to their "clients."
• Teach them to recognize the "trigger events" that can help them identify people who may be facing a healthcare choice or who should be reminded that they actually have such a choice.
• Make sure they know where to get information on related questions and concerns that consumers may raise, such as:
  • Health plan procedures for filing grievances.
  • How to find out if a particular physician or hospital accepts one's insurance.
  • How to find a specialist to address a specific health problem.
• Give intermediaries an opportunity to share their own concerns, including problems their clients have raised in the past. If you do not appear to care about what they care about, or what they perceive their clients care about, you will not gain their trust.

Training Logistics

It is seldom sufficient to provide a single session of training, primarily because there is often too much detail for a person to absorb about a particular report at one sitting. In addition to training at the outset, effective strategies include:

• Providing a call-in number or email address where intermediaries can get answers to specific questions within a short turnaround time.
• Especially at the beginning, setting up a monthly meeting, in-person or by phone, to provide updates on new information, review particularly complex issues, or identify and address problems people are experiencing when performing their new role.

Notes

1. Kaiser Family Foundation. 2008 Update on Consumers' Views of Patient Safety and Quality Information. 2008 October 15. Accessed March 19, 2009.
2. Berry S, Spranca M, Brown J. Consumers and healthcare quality information: need, availability, utility. Oakland (CA). California HealthCare Foundation. 2001. Accessed March 19, 2009.