While the future of healthcare reform in the United States remains uncertain, every day consumers continue to make decisions about their health and healthcare, and they are doing so in a rapidly evolving healthcare environment. Some are receiving care in new settings, such as retail clinics or virtual office visits. Many are navigating new health insurance benefit designs, including high deductible health plans that expose consumers to greater cost-sharing in exchange for lower monthly premiums. And some are shopping for doctors and hospitals to provide treatment for a range of “shoppable” conditions.
In response to this evolving landscape, the Robert Wood Johnson Foundation wanted to better understand how consumers are navigating the healthcare system, with a particular focus on their experiences, preferences, and values. Under a funding opportunity managed by AcademyHealth, they awarded 11 research studies in 2015 that sought to generate evidence on what consumers value in different care delivery settings, when they are buying and using insurance, and when they are shopping for healthcare.
These grants are wrapping up this year, and two grantees found unique insights into how patients perceive and value physician and hospital quality. David Schleifer, Ph.D., director of research at Public Agenda, and colleagues explored perspectives on quality among people who have experienced one of three common types of healthcare: type 2 diabetes care, joint replacement surgery and maternity care. They found that across all three groups, people value both interpersonal and clinical qualities of doctors and hospitals. The most common interpersonal quality that people across these three groups say is very important is that the doctor makes time for patients’ questions and concerns.
Interestingly, the researchers found differences between the three groups’ rating of interpersonal and clinical qualities (i.e. as very important, somewhat important, not too important, or not at all important). While most people recently diagnosed with type 2 diabetes and women who recently gave birth rated interpersonal qualities as very important, fewer rated clinical qualities as very important. Most people who recently had a joint replacement rated both interpersonal and clinical qualities as very important. Schleifer and colleagues conclude that it’s important to understand that people value different qualities of care depending on their health needs. The full findings from Public Agenda are detailed in a recently released report.
David Auerbach, Ph.D., director of research at the Massachusetts Health Policy Commission, and colleagues provide some additional insight into consumer perspectives on the value of different care settings (specifically community health systems versus academically-affiliated systems). They conducted focus groups with consumers finding that quality scores for physicians and hospitals mattered more for procedures that patients considered “risky,” such as cancer treatment or surgery. This observation aligns with Schleifer and colleagues’ finding that people who recently had a joint replacement surgery viewed clinical quality as very important, whereas for more routine care that perhaps was perceived as less risky, fewer patients rated clinical qualities as very important. In the case of more routine procedures, Auerbach and colleagues found that patients were more influenced by physician referrals and cost when choosing between community and academic settings.
While both studies found that patients do value clinical quality information about their doctors and hospitals, both also found that more work is needed to educate consumers about what’s included in clinical quality measures as well as how to find this information about doctors and hospitals. Schleifer and colleagues note that while many patients viewed clinical qualities as important, only some knew or tried to find out whether a doctor or hospital had these qualities.
The findings described here are a sneak peek of the full portfolio of grantees that will continue to come out over the next year. As these findings emerge, they will provide important evidence about how consumers are navigating new delivery settings, how they are buying and using health insurance and shopping for care, and how they are using information to make decisions to improve their health. Findings and publications will be posted on the program website.