How Will You Gain the Trust of Health Care Providers or Plans?

For some quality reports, little if any cooperation is required from the organizations whose performance is being reported. Many sponsors of reports on health plan quality, for instance, have relied on sources of publicly available data rather than the plans themselves.

However, this scenario is not as common with health care providers, some of whom are suspicious of quality measurement and reporting initiatives. Reasons for their suspicion include the following:

• Debate continues about the “right” way to measure provider quality.
• Providers worry that:
  • The data sources may be inadequate for accurate measurement of certain aspects of care.
  • The information may not accurately reflect their quality of care and services.
  • Even accurate results could be used inappropriately.
• When there are delays in releasing the quality report, the data may no longer reflect providers’ current performance.

If it all possible, it is preferable to gain the cooperation of providers on reporting efforts. If reporting becomes adversarial, it can get expensive, especially if legal fees are incurred. Physicians who disagree with a report can also undermine consumer trust in the information. To earn the cooperation and support of provider organizations, consider the following ideas for making the reporting process less threatening, less burdensome, and more valuable to the providers.

View Health Care Organizations as an Audience

Start by regarding the providers and plans as one of your key audiences for the report. While you may be designing it for consumers, the reality is that providers and plans are typically the audience with the greatest interest in the data. Research on report card use demonstrates that not only do providers and plans pay attention to the data, but they also act upon it.^[1]

Plan for Multiple Reporting Cycles

Use the first few reporting cycles to build providers’ comfort and experience with the data. For example:

• Make the first round of reports confidential so that providers have a chance to review, interpret, and respond to their results before the second round, which is public.
• Position subsequent rounds as opportunities to improve the measurement and reporting process, so that the providers and other stakeholders understand that changes can and will be made over time to make the report more useful to its audiences (including the providers).
• Consider hosting learning sessions that focus on how providers can use the metrics included in your report to make improvements.

Build Credibility

You can bolster your credibility as a report sponsor by being transparent about your methods. It is critical to offer health care organizations the information they need to be confident that the results you report will be accurate, fair, and valid. Be prepared to provide a justification for the measures and reporting strategies you want to use.

Also, if reporting on quality is new in your community, consider facilitating conversations between providers and purchasers to increase understanding about one another’s perspectives on consumer reporting. Have these conversations before reporting begins to clarify aims, during development to share updates on the process and progress, and after the results are computed to discuss the outcome.

Engage Providers in the Planning Process

To enhance credibility and gain buy-in, look for ways to bring providers into the planning process. Many reporting projects include provider representatives in an advisory board and/or a specific project workgroup.

In your messages to providers, link participation with the idea of “professionalism” or professional norms of behavior. For example, you may want to point out that the American Board of Internal Medicine has endorsed the regular measurement and reporting of performance data.

At a minimum, have a plan for communicating with the provider organizations at key steps in the project so that they are not caught by surprise. Keep them informed about your objectives and plans, including methods, schedule, progress, and issues that may affect them.

Elicit Feedback

Seek provider feedback at key points along the way:

• When selecting data sources and measures.
• When defining technical specifications.
• When computing results.
• When designing data displays.
• When planning the dissemination plan, including key messages for consumers.

For each reporting cycle, include ample time for a review and comment period in which providers have the opportunity to explore and ask questions about the results. Take action on legitimate concerns or suggestions for improvement.

Have a Back-up Plan

Consider what you can do in the event that providers don’t cooperate—or if cooperation comes too slowly or with too many compromises. Some sponsors that have tried to collaborate with providers and/or plans have not been able to move forward with a quality report. If that happens to you, you may want to consider alternative reporting strategies that are less dependent on provider involvement and consent.

Possibilities include the following:

• Use publicly available data and measures. (Learn more about sources of data and measures in Measures of Quality for Different Health Care Settings.)
• Pursue a legislative mandate to collect data and/or create public reports.
• Collect patient experience data (since it is possible to obtain sample information and conduct surveys without the direct involvement of health plans or providers).
• Promote awareness and use of national sources of comparative quality information such as Leapfrog and Hospital Compare.

^[1] Hibbard JH, Stockard J, Tusler M. Does publicizing hospital performance stimulate quality improvement efforts? Health Aff (Millwood) 2003 Mar-Apr;22(2):84-94. Also see: Laschober M, Maxfield M, Felt-Lisk S, Miranda DJ. Hospital response to public reporting of quality indicators. Health Care Financ Rev 2007 Spring;28(3):61-76.