Crafting a Yardstick for the Value of Health Care

All Americans want to get the best care possible every time they visit their local doctor or hospital, but determining whether the care they receive is truly high quality can be tricky. Most of us don’t hold medical degrees and can feel a bit overwhelmed trying to figure out which doctors and hospitals are best equipped to deliver the care we or our families need.

For several years, the Robert Wood Johnson Foundation (RWJF) has helped consumers get the information they need about their local providers through our Aligning Forces for Quality initiative in 16 communities nationwide. Each of our participating community ‘alliances’ have published public reports about the quality of care local physicians provide so they can be used by everyone who gets, gives, or pays for care in the region. These reports typically assess how health care providers perform on everything from chronic disease care to medication regimens, and have the added benefit of helping physicians and hospitals see how they compare to their peers, which can be a powerful motivator for improvement.

While that sounds simple enough, getting there is easier said than done. Hospitals, physicians and other groups that provide care can sometimes be resistant to change, especially as it relates to performance. Health care stakeholders who don’t always see eye to eye—like insurers, employers, hospitals and others—must work together to make sure they measure and report what we truly need to know about health care. And when all that hard work is done, it can be tough to get consumers to seek and use those reports.

Despite the challenges, all 16 alliances successfully convened diverse health care groups to measure and publicly report performance on the care of everything from diabetes to depression. In many instances, the work supported by RWJF builds on longstanding, grassroots efforts to create and report data on the quality of local health care. For example, Minnesota Community Measurement (MNCM) has focused since the early 1990s on getting doctors, hospitals, insurers and others to measure the care delivered in that state. Back then, state health care groups came together to develop guidelines around the appropriate use of antibiotics for urinary tract infections.

With RWJF’s support, MNCM has continued to serve as a national model for quality measurement. Today, MNCM is helping bring providers together to measure and assess everything from how doctors treat simple infections to more complicated measures that assess how hospitals, physicians and other health care providers manage costly, chronic conditions such as diabetes and heart disease, as well as how well they communicate with patients.

More recently, MNCM crafted a series of diabetes treatment guidelines, known as the D5, that track a given patient’s blood pressure, cholesterol, blood sugar levels, tobacco use and aspirin intake.

Crucially, MNCM crafted the D5 so that patients who achieve success on all five goals can reduce their overall risk for heart attacks and strokes, as well as problems with their kidneys, eyes and nervous system. Today, Minnesota physician practices can compare their performance in treating diabetes against nearly 50 similar practices.

While all of our alliances have found it challenging to connect consumers with the information they’ve published, health care leaders in Minnesota and elsewhere believe that the mere process of measuring the care provided in their state—and making those assessments readily available to the public—have been powerful motivators for doctors and hospitals to improve the way they treat patients.

Minnesota health care stakeholders are now working on creating a measurement for health care costs. And through an additional grant from RWJF, they’re launching ‘The DOCTOR Project,’ a major effort to help 10 communities create consumer-friendly ways to assess and report on the care local physicians provide.

Ultimately, we believe that developing and sharing consumer-friendly information on the cost and quality of the care provided in communities is a vital part of creating a nationwide Culture of Health. We are proud of the pioneering work being done in Minnesota and elsewhere and look forward to future efforts to increase transparency in American health care.

Anne F. Weiss, MPP, leads efforts to improve the value of U.S. health care at the Robert Wood Johnson Foundation, Princeton, NJ.