What do patients think makes for high-quality care? This is the question that the Public Agenda’s July 2017 report “Qualities That Matter: Public Perceptions of Quality in Diabetes Care, Joint Replacement and Maternity Care” sets out to answer. The report compares the perspectives of Americans who experience one of three common health care conditions, type 2 diabetes, maternity care, or joint replacement. Not only do services associated with these conditions claim a large portion of health care costs for purchasers, they are also ripe with a wide variation in provider quality. What draws the eye in this report is the way the researchers have dug deeper to test the validity and implications of two commonly cited ideas in today’s health care world: 1) that quality of care from a patients’ perspective centers on the providers interpersonal skills, and 2) that patients are increasingly aware that price and quality variation exists between different doctors and hospitals. Let’s find out what they discovered…
What does it mean that patients care about provider interpersonal skills, like communication and listening? Does it mean that patients care less about clinical measures of quality of care? Turns out, patients care about both interpersonal and clinical measures, but to varying degrees depending on their health care needs. While only 43% of women who had given birth in a hospital ranked a doctor’s clinical measures as very important, 83% of the joint replacement surgery patients ranked doctor clinical measures the same way. The joint replacement patients surveyed were less likely than the surveyed diabetic and maternity patients to rank provider interpersonal skills as very important. Public Agenda’s research shows that the relative importance of different aspects of provider quality varies among people with different health needs. There was one commonality across all three patient groups: a doctor taking the time to discuss a patients’ questions and concerns was the most common interpersonal metrics that patients rated as ‘very important.’ This message should be taken to heart. Payment reform provides options for purchasers and payers to align incentives in a way that addresses the concern of a doctors spending the necessary time with a patient, like paying a provider a salary instead of a fee-for-service payment.
Do today’s patients understand that price and quality variation exists among providers and hospitals? Many would argue that yes, especially given the rise of consumerism in health care. What the Public Agenda report points out, however, makes this commonly cited assumption a moot point. The research found that 47% of women for maternity care and 42% of patients for joint replacement surgery only had one hospital available. What’s the point of offering price and quality transparency if there’s no opportunity to make a choice? Combining this finding with the extremely low rate of patients switching providers mid-treatment reinforces the views that CPR’s purchaser members know all too well: benefit design is the first ticket to steering patients to higher-value care. Only 10% of the diabetes group, patients who have years and years of treatment and disease management to switch doctors if necessary, switched doctors. In that vein, it’s heartening to see that 15% of patients from both the diabetes group and the maternity group used their insurance company or their insurance company’s website to discover from which provider they should seek care. To raise that number, CPR knows that employers are frequently hiring navigation support for their employees.
By surveying a representative sample of the American public to compare the perspectives of each group of patients, the Qualities that Matter report succeeds in advancing the dialogue on patient-centered quality measures. By combining focus groups with a robust survey methodology, the authors and their funder, the Robert Wood Johnson foundation, offer many insights. This research will inform CPR’s work, and we recommend other catalysts read it as well. Happy reading!