Module 6: Consumer Incentives

Multi-stakeholder Community Inventory Modules

Community quality collaboratives are community-based organizations of multiple stakeholders, including health care providers, purchasers (employers, employer coalitions, Medicaid and others), health plans, and consumer advocacy organizations, that are working together to transform health care at the local level. The Agency for Healthcare Research and Quality offers these organizations many tools to assist in their efforts.

Your Goals in This Inquiry

  • Identify which plans and/or purchasers have implemented consumer incentives, and in particular, provider tiering and their goals, results and lessons learned.
  • Identify the historical context of consumer incentives (e.g., what has been tried in the past).
  • Explore specific types of consumer incentives (e.g., provider tiering — charging patients less for visits to high-value providers and more for visits to low-value providers, incentives for healthy behaviors) that could be implemented to improve quality and/or lower cost.
  • Identify the extent of publicly reported provider performance data, as well as response by consumers to the information available.
  • Explore how consumer incentives may be implemented in your market to improve health and quality and/or lower cost.
  • Explore pros and cons of aligning across plans, and of aligning consumer incentives with provider report card and incentive/rewards programs.
  • Explore how to increase the effectiveness of consumer incentives in producing desired behavior changes including addressing issues of low health literacy.

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Information You May Want to Gather

  • Local health plans' tiered products.
  • Benefit plans of major health plans, local employers, the state Medicaid program, or counties as purchasers. Assess key features such as presence of:
    • Tiered networks.
    • High deductible plans.
    • Incentives for healthy behaviors.
    • Wellness programs.
    • Web-based information regarding costs and quality of providers.
  • The extent of publicly reported information on provider quality and cost.
  • Local experts in behavior change.

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Key Individuals to Contact

  • Purchasers, employers, business coalitions, labor, and Medicaid that have implemented programs to encourage healthy behaviors through tiering their networks or other aspects of their benefit plans, or who are implementing value-based benefit plans.
  • Health plans that have designed benefits with consumer incentives.
  • Locally based companies with expertise in consumer marketing (whose business is to provide incentives for consumer behavior change).
  • Providers who have experience with patients with varying incentives including high deductible plans or incentives for choosing providers or for healthy behavior.
  • Consumer advocacy organizations.
  • Experts in consumer driven health plans.

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Other Individuals to Consider Contacting

  • Quality Improvement Organizations (QIOs) with experience interfacing with providers in response to public reporting of hospital performance.
  • Local health and wellness programs.
  • Academia, researchers.
  • Public health agencies that have implemented programs with consumer incentives.
  • Other organizations that have experience with varying benefit plan designs for their products.

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Suggested Questions

Communitywide Consumer Incentives

  • Have there been communitywide discussions, collaboration, or social marketing efforts related to consumer incentives and in particular, provider tiering?
  • If so, what impact have they had and what has been the reaction of the provider community?
  • What is the position of provider organizations regarding consumer incentives generally?
  • Have purchasers, including self-funded employers, business coalitions, or Medicaid discussed how to advance consumer incentives across the community?
  • To what degree do health plans compete on consumer-directed initiatives in your market place?
  • If applicable, how would you ensure that rural areas are included in consumer incentives activities?
  • Are there geographic issues, such as distances, market service areas, local jurisdictions, or other boundaries, that may pose challenges to implementing consumer incentives?
  • Are there demographic issues such as age, income, or education levels that need to be considered?
  • Do you see any individual stakeholder as dominant in this market, for example, purchasers, providers, or health plans? If so, how might that impede or support the Community Quality Collaborative's goals related to consumer incentives?
  • How do you anticipate supporting consumers in implementing consumer incentives?
  • Is there alignment of consumer incentives with provider report card and incentive/rewards programs?
  • Is health literacy addressed in existing or planned consumer incentive programs?

Stakeholder-Specific Consumer Incentives

  • What initiatives have you and others in your stakeholder group been involved with that included consumer incentives, especially tiering?
  • Describe the programs and their impact on consumer behavior.
  • What were/are the goals and results of those initiatives?
  • What are the lessons learned?
  • If applicable, do current Web-based tools, including information on quality and cost of providers, have an impact on consumer behavior?
  • Please describe any new initiatives you have underway related to consumer incentives.
  • Who is involved? How should they be involved in the Community Quality Collaborative?
  • What are your goals and plans for the future related to consumer incentives?

Future Community Quality Collaborative Consumer Incentives

  • What could your organization contribute to the Community Quality Collaborative relative to advancing a consumer incentive agenda?
  • How do you envision being involved in the goals of the Community Quality Collaborative?
  • What do you see as the role of the Community Quality Collaborative in consumer incentives?

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Compiling Results

Tracking your activities and results of your inventory in a table similar to the one below will be useful for reporting activities to the Leadership Team.

Consumer Incentives — Activities and Results
Interviewee NamePosition, OrganizationSummaryConclusions/Next Steps
    
    
    
    
    
    
After data have been gathered from all sources in the focus area, the Focus Area Team Leader and members may analyze the results by reviewing the goals identified at the beginning of this section and by identifying and summarizing the following aspects of the inventory findings with each other and with other Focus Area Team Leaders.
Consumer Incentives — Analysis
Gaps 
Overlaps 
Opportunities for Alignment 
Challenges 
Lessons Learned 
Resources 
Leaders 

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Consensus Score Card

You may wish to develop a score for your Community Quality Collaborative's stage of development in each focus area to facilitate comparison of its stage of development across focus areas. You may discover differences in scores of individual key stakeholders for the same question. Identifying the degree of consensus among stakeholders will be useful in clarifying differing perceptions and goals and areas where consensus building may be useful for more effective collaboration.

If a quantitative approach doesn't fit in your situation, you may wish to use a more qualitative approach such as identifying areas of strengths and weaknesses or specific challenges and solutions.

  • Ask each team member to answer the following questions on a scale of 1-10 with 1 being the least developed and 10 being the most developed.
  • Average the scores of the team members, for each question, to get an average score per question.
  • Discuss any major differences between team members' scores to gain an understanding of each other's perspectives and knowledge.
  • Total the scores for all the questions and divide by the number of questions to get the score for this focus area.
  • Compare your Community Quality Collaborative's strength in this focus area to its strength in other focus areas in the overall Community Inventory Consensus Score Card when compiling and analyzing overall results from the tool.
Consumer Incentives Consensus Score CardSCORE
(1-10)
1. Our community has collaborated on initiatives related to consumer incentives. 
2. These efforts have been successful. 
3. Health care providers in our community support consumer incentives. 
4. Some of the Community Quality Collaborative stakeholders been involved in implementing consumer incentives. 
5. The Community Quality Collaborative includes the right stakeholders relative to consumer incentives. 
6. The Community Quality Collaborative includes the right individuals to advance a consumer incentives agenda. 
7. The organizations involved in the Community Quality Collaborative are willing to share expertise and capabilities around consumer incentives for the benefit of the community. 
8. The organizations involved in the Community Quality Collaborative are willing to share resources, in-kind, financial or other, in pursuing consumer incentive goals. 
9. The members of the Community Quality Collaborative share a common vision of consumer incentives and their role in value-driven health care. 
10. Health plans in the community are willing to share relevant knowledge openly and collaborate, where necessary, to implement more effective consumer incentives. 
11. The individuals at the table are willing and able to advocate on behalf of the Community Quality Collaborative's consumer incentive goals in their respective organizations. 
12. Employers are implementing value-based benefit plans that remove barriers to appropriate care and provide incentives for healthy behaviors. 
13. A large segment of consumers in our market have incentives for provider choice and healthy behaviors built into their benefit plans. 
14. In our community, consumer communication about incentives is simple, easy to understand, and effective in changing behavior. 
15. There are sufficient resources for this Community Quality Collaborative to achieve its consumer incentives goals. 
16. The participants will devote adequate time and resources to the consumer incentives goals. 
17. The Community Quality Collaborative will seek outside expertise if needed to achieve its consumer incentives goals. 
Total Score 

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Current as of March 2009
Internet Citation: Module 6: Consumer Incentives: Multi-stakeholder Community Inventory Modules. March 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/value/cimodules/cimodules6.html