What Is the Environment for Reporting on Health Care Quality?

Whether working alone or in collaboration with others, report sponsors need to understand:

• The circumstances in which the reporting project will take place.
• The likely implications of the project for:
  • The sponsoring organizations,
  • The organizations you’re reporting on, and
  • Your audience.

The search for information about the local environment will help you identify the factors that are most likely to affect your project and its effectiveness. Even a quick review of the local marketplace can keep you from getting into a situation that is either politically inadvisable, financially infeasible, or simply a waste of time. It can also help you identify other local efforts that you could leverage and/or partners with whom you could collaborate.

Availability and Degree of Choice

One thing you will need to determine is whether your audience has health care choices to make and the nature of those choices.

If your audience is choosing insurance plans:

• Can your audience choose among different kinds of coverage options (e.g., fee-for-service carriers, PPO plans, HMOs)?
• Do they have multiple choices within each of those options?

If your audience is choosing a health care provider:

• Can the consumers choose among providers?
• How extensive are those choices? For example, do they typically have access to several medical groups or just a few?
• Are consumers’ perceptions of those choices consistent with their actual choices? For example, do the consumers in your audience perceive that they have a choice among the multiple hospitals that are actually available to them?

The answers to these questions can help you determine how to make the information you have relevant and useful to your audience.

What if your audience is large and heterogeneous? If your potential audience is very large and varied (e.g., if you are producing a report that anyone in the State might consult), you may need to break it down into segments. This means identifying distinct segments within your audience, estimating the size of those segments, and characterizing their choices. For instance, some segments may have no choice among health plans or providers, while others have several.

Dominant Organizations in the Local Market

Many report sponsors are already familiar with the major health care organizations and other stakeholders in their market. It can be helpful to document what you know about them so that everyone involved is clear on who will be affected by reporting decisions. Since markets can change over time, documenting basic facts about the current market can help you and future participants in the reporting project keep track of changes over time, especially ones that may affect future reporting efforts.

Questions to ask about local health plans:

• Do managed care plans dominate the market? What kinds? Which ones?
• Are the plans owned and managed at the National, regional or local level?

Questions about health care providers:

• Do major providers—either hospital systems or medical groups—play a large role in shaping the market?
• Are any of them especially dominant?
• What’s the nature of the relationships among providers? For example, are most of the local hospitals owned by one system? What is the relationship between physician groups and local hospitals?

Questions about purchasers and regulators:

• Among health care purchasers, who (if anyone) is most involved in reporting on quality to consumers? Who are the leaders in driving improvements in quality and/or value in your market?
• Have purchasers formed a coalition? Is the coalition a focal point for work on quality issues among employers?
• Is a State agency or other regulatory body involved in quality measurement and reporting in your marketplace?

Questions about multistakeholder initiatives:

• Is there a multistakeholder initiative focused on health care quality in the community?
• If so, what are their goals and what are they working on?
• Was there ever a multistakeholder initiative in the community? What happened to it?

Questions about other reporting initiatives:

Look at any other reports on quality in your area to identify information needs and gaps. These include local reports as well as ones with a national reach, such as reports produced by the Centers for Medicare & Medicaid Services, the National Committee for Quality Assurance, Consumer Reports, and U.S. News & World Reports.

• Who else is providing information about quality to the audience you hope to reach?
• What information do they provide?
• How long has this information been available?
• How have health plans and providers responded to previous attempt to report on quality (if any)?
• How is what you are thinking about doing the same or different? Where could confusion or even dissension arise?

Questions about consumer/patient groups in your area:

• Who is working actively with consumers, particularly patients? Possibilities include senior groups, disease-specific advocacy groups, and children/family groups.
• What services do they provide?
• How does health, and specifically quality, fit into their scope?
• Which groups are most prominent? Which have promise as partners?

Finding this information. Answers to the questions above may come from a variety of sources, including:

• The State’s Department of Insurance.
• State or local Departments of Health.
• Local and regional media coverage of the industry.

Costs and Benefits of Public Reporting

Whether you are reporting on quality voluntarily (e.g., as a private purchaser) or because you are mandated to (e.g., by State legislation), it is useful to assess the potential costs and benefits of this reporting effort.

Questions about the political implications of public reporting:

• Which stakeholders might be affected by this information? Positively? Negatively?
• What reaction can you expect from them?
• Who is likely to become an ally in this effort?
• Who may be opposed to your project?
  • How can you learn about the underlying as well as the stated reasons for their opposition?
  • What can you do to make allies out of these potential detractors?

Questions about staffing implications:

• Do you currently have the manpower to undertake this kind of project? Consider how much staff will be needed to cultivate and maintain relationships with stakeholders and providers, to collect and manage the data, to produce the actual report, and to distribute, promote, and support the report.
• Do you have the expertise in-house for all of the steps involved in effective reporting?
• If not, can you afford to hire or contract for certain expertise? Do you have access to high-quality consultants?

Questions about financial implications:

• Can you predict expenses with some confidence, or will it be hard to anticipate future costs?
• Do you have access to sufficient funding in the short term?
• Will you have sufficient funding to maintain this reporting effort over time?

Learn more about Managing a Reporting Project.

Also in "Get Started: What You Need To Know"

• Who Is Your Audience?
• What Are Your Objectives?
• What Is the Local Environment for Consumer Reporting?
• Who Are Potential Partners?
• What Will Be the Subject of Your Report Card?
• What Quality Measures Will You Report?