Other Information You Can Share

• Where the Data Came From.
• Consumer Rights and Protections.
• Procedures for Complaints, Appeals, and Grievances.
• Where to Get More Information.
• Vignettes and Factoids.

Where the Data Came From

Most reports with comparative data on quality contain some explanation of the methodology that the sponsors used. A discussion of the methodology generally indicates where the information came from, how it was collected, who collected it, and when. It may also include technical information, such as the source of the data and the sample size used in the calculations of scores.

Who Cares About Methodology?

Interest in the methodology will depend on who is in your audience. Some consumers will trust the information and you as its source, or may simply not think to question what they are seeing. For others, this kind of information is very important to establishing the credibility of the data; an audience of highly educated professionals, for instance, may need to be convinced that you used a fair and valid approach to evaluating the health care organizations. But for most people, it is sufficient to know that the sponsor went through the trouble of explaining the methodology. They may not want to read it, but they do want to know that you can defend what you have done.

While you may guess at the interest level of your audience based on your knowledge of its characteristics, the best way to determine whether they need to hear about the methodology is to ask them. This is one of the benefits of testing the report with consumers during the development stage. Use that opportunity to find out how much they really want to know and how critical that information is to their acceptance of the data.

For details on these topics, go to How Your Audience Influences What You Say and Testing Your Materials and Dissemination Strategy.

What to Tell Those Who Care

At a minimum, you need to provide enough information to address any questions readers might have about the data. For instance:

• Who is sponsoring the information? Are you an independent organization? If you represent someone (e.g., employers), say so.
• Who answered the survey (e.g., health plan members, hospital patients, consumers)? Were they randomly selected? How many people were involved?
• When was the data collected?
• Was the data collection and analysis independent of the health care organizations? If not, was a system in place to ensure the reliability and accuracy of the data (such as auditing)?

Present this information as directly and concisely as possible. While the data collection and analysis process may have been complex, you need to filter out the details to highlight the aspects of the methodology that are relevant to the reader.

 Choice Plus: The Twin Cities-based Buyer's Health Care Action Group distributes an annual report on the quality of care systems that keeps its explanation of methodology short and sweet, providing basic information in the front of the report and more detail in the back (PDF file, 1.6 MB; HTML).
© Copyright 1999. Buyers Health Care Action Group. All Rights Reserved. Used with Permission.  

Discussions of methodology are usually part of the material in either the front or back of a report. However, it may also be appropriate to incorporate information on the methodology into the presentations of data. For instance, several States have produced report cards in which each measure is shown with an icon that indicates the source of the data: member surveys or medical records.

Comparing the Quality of Maryland HMOs 1999 (PDF file, 105 KB; HTML) shows the source of data for each measure.
© Copyright 1999. Maryland Health Care Commission. All Rights Reserved. Used with Permission.

The extent to which you explain the methodology also depends on what media you use. On paper, technical information can add unwanted heft and may make a report seem less approachable. On the Web, however, such information can be hidden from those who aren't interested but made easily accessible for those who are. Also, it is more feasible to provide layers of technical detail and documentation.

Consumer Rights and Protections

A report on the performance of health care organizations is an ideal place to remind consumers of their rights and protections. This applies to those with commercial coverage as well as people in Medicare or Medicaid.

The Medicare handbook, Medicare & You 2002 (PDF file, 334 KB; HTML) explicitly tells beneficiaries their rights as patients.

Tell people what they are entitled to do. For example:

"You have the right to appeal the judgment of the plan."

"You have the right to a second opinion from a physician in your health plan's network."

"You have the right to change your primary care doctor."

"You have the right to switch plans after 30 days (for Medicare beneficiaries)."

In addition, tell people what the health care organizations are allowed to do. For example:

"Health plans do not have to cover certain kinds of care."

"Health plans may require that you obtain a referral from your primary care physician to see a specialist."

This kind of information reinforces the message that people have choices, that those choices have consequences, and most importantly, that information can help them make the choice that is best for them.

The booklet, Thinking about joining a Medicare HMO? (PDF file, 297 KB; HTML) provides Medicare beneficiaries with information about their rights.
© Copyright 2000. Baruch College School of Public Affairs. All Rights Reserved. Used with Permission.

Procedures for Complaints, Appeals, and Grievances

A health care organization's performance is not predictive of the experience of every individual consumer. For instance, a health plan enrollee may have a bad experience getting needed services even from a plan that has earned high scores for access to care. This message is implicit in most performance reports, although some sponsors actually say this explicitly; for example, the Buyers Health Care Action Group's Consumer Survey Results 2000 tells the reader that "Your own experience with a clinic or Care System could be different from those of the people who were surveyed."

For those consumers who are not happy with the care they are receiving, a performance report is not enough. What they need to ensure quality of care is a means of righting a wrong. For that reason, some sponsors include information on how consumers can resolve issues when they are dissatisfied with the care or service they receive. They explain what kinds of problems constitute legitimate complaints, how to file a complaint or appeal with a health care organization, who to contact to file a grievance with a State agency, and what kind of response to expect. If appropriate, they also provide contact information for government agencies or independent organizations that can help consumers resolve their problems. In addition, some States have established consumer rights and grievance procedures that apply to all health plans operating in that State.

The Community Service Society of New York's booklet, Your Health Plan Handbook: How to Get the Healthcare Your Family Needs from a Managed Care Plan (PDF file, 504 KB; HTML), lists potential problems that Medicaid beneficiaries should complain about. This booklet also explains what to do within the plan and outside of the plan, and what to say when you make a complaint.
© Copyright 1997. Community Service Society of New York. All Rights Reserved. Used with Permission. 

Where to Get More Information

In addition to the information that consumers need to make sound decisions, there is a lot of information that consumers would like to know, even if it doesn't get factored into their decisions. Some examples of information consumers may want to get include:

• Contact information for each plan.
• The geographical service area for each plan.
• The hours of operation for clinical care and for member services.
• The location and hours for urgent care.
• How each plan defines an emergency (in layman's terms).
• How each plan defines experimental and investigative procedures and drugs.
• How plans determine medical necessity.
• Services that plans will not cover, such as ambulances and cosmetic surgery.

One approach is to incorporate some of this information into your report. This would be helpful to readers, although it places the burden on you to gather all this data and confirm its accuracy. The downside is that this descriptive information may lead readers to think that all of the information—including the quality measures—came from the health plans rather than an objective source. To maintain their trust, be sure to explain the role of the plans in creating the quality data and the means taken to ensure the credibility of the quality information. For more on explaining your methodology, go to Where the Data Came From.

A less cumbersome alternative is to help consumers identify what they want to know and the sources for whatever they may be missing. You can do this by providing consumers with a checklist of issues to consider when considering health plans (or providers) and a list of sources for different kinds of information.

Comparing the Quality of Maryland HMOs 2000 (PDF file, 219 KB; HTML) provides a worksheet for gathering and organizing different pieces of information.
© Copyright 2000. Maryland Health Care Commission. All Rights Reserved. Used with Permission.

Medicare & You 2002 (PDF file, 674 KB; HTML) tells beneficiaries where they can get more information.

Vignettes and Factoids

Quality reports can be boring. Even when the results are easy to understand, the idea of wading through the material is often not very appealing. Some sponsors tackle this problem by incorporating short pieces of information that catch the readers' attention and draw them into the material. This approach can make the information in your report appear more concrete and relevant to your readers' day-to-day concerns.

Possibilities include:

• Personal stories or vignettes

  Stories can help readers see how individuals like themselves think about health care and how they make decisions. You can include quotes from typical audience members regarding their concerns about quality, or show how a fictional consumer uses the information to pick a plan that meets the criteria that are most important to her.

• Health-related facts and advice

  Brief news stories and helpful hints can contribute to the overall sense that your report is intended to provide useful information that can help consumers get better health care. Topics may include nutrition, exercise, and tips for people with specific conditions and diseases (such as pregnancy or asthma). This is also a good way to introduce the ground rules for health care organizations and suggest ways for people to use the health care system more effectively (e.g., when to call 911, what to expect at the emergency room, when to get flu shots).