Communicating with Consumers About Health Care Value: A Controlled Experiment

On September 20, 2011, Judith Hibbard made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (2 MB). Plugin Software Help.

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Communicating with Consumers About Health Care Value: A Controlled Experiment

Judith Hibbard and Jessica Greene, University of Oregon
Shoshanna Sofaer and Kirsten Firminger, Baruch College
Judy Hirsh, Health Improvement
Collaborative of Greater Cincinnati

Funded by AHRQ.
Data collected in collaboration with Massachusetts Health Quality Partners (MHQP).

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Communicating about Cost and Resource

• Consumers tend to think that when it comes to medical care, that more is better.
• Some consumers may equate higher cost with higher quality care.
• We explore communication strategies that overcome these beliefs.

Slide 3

Research Questions

• Are there more and less effective ways to present data about cost so that consumers choose high value providers?
  • Does the labeling of cost impact consumer likelihood of valuing it?
  • Is cost data more likely to be correctly interpreted when there is a strong quality signal?
• Are there more and less effective ways to present resource use measures—such as "imaging" for improving choices and comprehension of concept?

Slide 4

Study Population

• Employees from 2 large employers (n=1421).
• Data collected by 2 employers and sponsored by MHQP:
  • Respondents randomly assigned into 3 groups.
  • Online survey, data collected April—June 2011.

Slide 5

Study Population

• No Differences in demographic characteristics across the three study groups:
  • Average age 45.
  • 62% male, 81% white.
  • 70% have college education.
  • 38% had at least one chronic illness.
  • 22% in high deductible health plans.

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Design, Part 1

• Experimental design with respondents randomized to view one of three cost labels:
  • Careful with your health care dollars.
  • Average cost of office visit (dollar amount).
  • Average cost of office visit ($,$$,$$$).
• Each respondent viewed 3 comparative primary care physician (PCP) tables:
  • No quality signal (only convenience measures).
  • Weak quality signal (detailed measures with percentages).
  • Strong quality signal (summary measures with word icons).

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Group 1
Careful with your health care dollars
No Quality Signal

Image: A table compares information on sample physicians, including driving distance, whether they have weekend hours and same-day office visits, and how careful they are with your health care dollars.

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Group 2
Dollar Amount
No Quality Signal

Image: A table compares information on sample physicians, including driving distance, whether they have weekend hours and same-day office visits, and average cost per office visit in specific dollar amounts.

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Group 3
Dollar Signs
No Quality Signal

Image: A table compares information on sample physicians, including driving distance, whether they have weekend hours and same-day office visits, and average cost per office visit with dollar signs ($) indicating a price range below/at/above average.

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Group 3
Dollar Signs
Quality Signal: Weak

Image: A table compares information on sample physicians, including percent of diabetes patients treated, whether electronic medical records are used, helpfulness of staff, and average cost per office visit with dollar signs ($) indicating a price range below/at/above average.

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Group 3
Dollar Signs
Quality Signal: Strong

Image: A table compares information on sample physicians, including use of proven treatments, safeguards against medical errors, response to patient needs and preferences, and average cost per office visit with dollar signs ($) indicating a price range below/at/above average.

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Percent Choosing High Value (Lower Cost) Provider

Image: A bar graph presents the following data:

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Average Score on Confidence in Choice

Image: A bar graph presents the following data:

1= low confidence; 4 = high confidence.

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Percent That Believe High Cost Option is Best Quality

Image: A bar graph presents the following data:

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Design, Part 2
Reporting on Resource Use

• Experimental design with respondents randomized to view one of groups:
  • Physicians who use a low, medium, or high number of MRI's and CAT scans.
  • Physicians who use a low, medium, or high number of MRI's and CAT scans (data shown with a framing statement, suggesting more is not always better).
  • Physicians who use the appropriate number of MRI's and CAT scans.
• Experimental design with respondents randomized to view one of three groups:
  • Hospitals with cost and quality information.
  • Hospitals with cost, quality, and best value.
  • Hospitals with cost.

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Group 1
Resource Use

Image: A table compares information on sample physicians, including driving distance, whether they have weekend hours and same-day office visits, and use of MRI's and CAT scans.

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Group 2
Resource Use With Framing

More isn't always better: Too many imaging tests can be harmful.

Image: A table compares information on sample physicians, including driving distance, whether they have weekend hours and same-day office visits, and use of MRI's and CAT scans.

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Group 3
Resource Use, with a label that interprets data

Image: A table compares information on sample physicians, including driving distance, whether they have weekend hours and same-day office visits, and whether they use MRI's and CAT scans only when appropriate.

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Percent Selecting High Value Provider

Image: A bar graph presents the following data:

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Group 1
Selecting Hospitals—Cost only

Image: A table compares information on sample hospitals, including driving distance, use of electronic records and prescribing, and average costs.

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Group 2
Selecting Hospitals—Cost and Quality

Image: A table compares information on sample hospitals, including driving distance, use of electronic records and prescribing, quality of care, and average costs.

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Group 3
Selecting Hospitals—Cost, Quality & Best Value

Image: A table compares information on sample hospitals, including driving distance, use of electronic records and prescribing, quality of care, average costs, and high value (high quality and low cost).

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Percent Selecting High Value Hospital

Image: A bar graph presents the following data:

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Other findings

• Findings do not differ for those in a high deductible plan vs traditional PPO or HMO.
• Finding do not differ by demographics.
• Findings do not differ based on health status.

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Summary

• A significant minority of consumers view cost as a proxy for quality and/or avoid low cost providers.
• How cost is portrayed does make a difference in how it is interpreted and used. Use of dollar signs ($$) least effective approach.
• When a strong quality signal is paired with cost information, consumers are more likely to choose the high value option. They also report higher confidence in their choice.
• Consumers need help interpreting data—particularly when it comes to resource use. When labels that interpreting data are used, consumers are more likely to choose high value provider. (e.g. Careful with your health care dollars; Appropriate MRI use; High value hospital). It helps consumers to "call out" high value providers in the data display.

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Conclusions

• Considering cost information is new for consumers.
• They need help in interpreting the information.
• Failure to send a strong quality signal along with cost information could undermine our efforts to stimulate high value choices among consumers.