Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

AHRQ Director Carolyn Clancy, M.D., has prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They will address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan. Check back regularly for new columns.

As a savvy consumer, you shop around and compare prices before you make a big purchase. Thanks to the Internet, information about price, quality, and opinions from others takes just a few clicks of your mouse.

But information to help you make good decisions about the cost and quality of health care is not as easy to find.

That may be one reason that consumers still tend to think expensive health care providers are better than lower cost providers, according to a new study funded by the Agency for Healthcare Research and Quality (AHRQ). This conclusion is often wrong, because higher costs can be due to services you don't need. Or it can be from inefficient, but not better, care.

This study had a silver lining, though. Consumers are less likely to select costly providers when they have data that allows them to choose high-value health care providers. High-value providers are those with good quality and lower costs.

This study shows that consumers need information about both cost and quality—in one place—to make good decisions about their care.

Currently, more than 150 public reports, also known as "report cards," rate the quality of care from doctors, hospitals, and nursing homes. Despite the growing amount of information, more work is needed to make it easier for consumers to identify high-value care.

Still, public reports from Federal, State, and private entities provide data that was not available a decade ago. They can give you a good starting point to learn about and compare health care providers in your community. They can also help you ask questions that will help you make better decisions about your care.

Hospital Compare is one example. It's an online resource for consumers from the Medicare program and the Hospital Quality Alliance. It can tell you whether a hospital provides medically sound care for heart attacks, pneumonia, and heart failure. (Hospitals report this information on a voluntary basis, but they get higher Medicare payments if they participate).

Hospital Compare can also tell you if Medicare patients died 30 days after they were admitted or if they had to be re-admitted after they were released. This information can help you learn more about how well a hospital tries to prevent complications or helps patients once they get home or to another setting.

To get more accurate information on cost and quality for providers and consumers, AHRQ supports a national learning network for community quality collaboratives, which are also known as chartered value exchanges. Formed in 2007, the network is made up of 24 collaboratives in 22 states. Most of them currently sponsor public reports on hospitals or physicians at the local level or are planning to do so.

A national employer organization called The Leapfrog Group surveys more than 1,000 hospitals each year to find out where they stand on safety and quality standards. You can check their public report to see how hospitals compared in providing care for heart attacks, pneumonia, and weight-loss surgery.

I'm encouraged to see that consumers can recognize the difference between high cost and high quality when relevant information is presented in a way that makes it easy. But I know we need to do a better job creating public reports and other resources that truly inform consumers about recognizing value in health care and knowing how to find it.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality

Agency for Healthcare Research and Quality 
Study Finds Consumers Choose High-Value Health Care Providers When Given Good Cost and Quality Information
http://www.ahrq.gov/news/press/pr2012/highvaluepr.htm

AHRQ Learning Network for Chartered Value Exchanges
http://www.ahrq.gov/qual/value/lncveover.htm

Community Quality Collaboratives
 http://www.ahrq.gov/qual/value/localnetworks.htm

Questions are the Answer: Tips and Tools
http://www.ahrq.gov/news/press/pr2012/highvaluepr.htm

Centers for Medicare & Medicaid Services
Medicare Hospital Compare Information for Consumers: Overview
http://www.hospitalcompare.hhs.gov/staticpages/for-consumers/for-consumers.aspx

The Leapfrog Group
http://www.leapfroggroup.org/for_consumers

Current as of April 2012
Internet Citation: Consumers Learning To Recognize High-Value Health Care Providers. April 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/040312.html