REPORT CARDS: Still Not Catching On Among Consumers
Health plan report cards influence health plans more than employees, according to a new study by the Washington, DC-based Economic and Social Research Institute (ESRI). ESRI President Dr. Jack Meyer, coauthor of the Report on Report Cards, said, "Our findings suggest that the report cards do not yet have a significant impact on the way employees choose plans, but health plans still care a great deal about the performance ratings." He said the study showed that health "plans seek to improve areas of performance that seem deficient because they do not want to be seen as inferior to competitors. So even if consumers make minimal use of report cards, they seem to promote better performance from health plans." Workers who participated in focus groups said they did not see the information in the report cards, or if they did, it was often not exactly what they wanted to know. Most of the employees surveyed said they wanted the report cards to focus more on "cost, coverage and keeping the relationship with their doctors." They also wanted more simplified formats and more evaluations of physician performance. According to the survey, employers who want to make report cards more useful need to find better ways to measure quality and promote consumer understanding of how to use the information and recognize its importance and limitations.
Survey Also Says
The ESRI study was based on site visits to five states where business coalitions or public employers are experimenting with report cards and financial incentives. The study found that General Motors' salaried employees are migrating to the better-performing plans because they are presented with information ranking health plans on cost and quality and are given financial incentives to select a good plan. A purchasing group representing state and local government employees in Missouri has quadrupled the proportion of workers enrolled in managed care plans over a four-year period, in part by gearing its contributions to the lowest-cost plan in each region of the state. The study found that the California Public Employees Retirement System (CalPERS) has produced three rounds of useful report cards and uses feedback from consumers to improve them each year. Further, for the fifth year in Cleveland, report cards on hospital quality are accepted as valid and useful by key players in the health care system.
Just The Beginning
Study coauthor Dr. Elliot Wicks said that, although it is premature "to come to definitive conclusions," he is "optimistic" about research results. "These innovations are still at the experimental stage. As they improve and employees get more used to seeing performance assessments, we think they will use that information to choose health plans and providers. That will have a significant positive impact on the health system," he said. ESRI collaborated with the Midwest Business Group on Health in conducting the study. The study also received support from the Robert Wood Johnson Foundation's Health Care Financing and Organization (HCFO) program (ESRI release, 3/23).