Engaged Patients Will Need Comparative Physician-Level Quality Data And Information About Their Out-Of-Pocket Costs
(Impact Factor: 4.97).
02/2013; 32(2):328-37. DOI: 10.1377/hlthaff.2012.1077
For patients to be engaged, they will need meaningful and comparable information about the quality and cost of health care. We conducted a literature review and key-informant interviews, reviewed selected online reporting tools, and found that quality and cost reporting fell into two categories. One emphasizes public reporting of information, supported by philanthropic or government institutions that aim to improve provider quality and efficiency. The other is characterized by proprietary websites that aim to provide personalized, integrated information on cost and quality to support consumers' decision making on providers and services. What consumers seem to want is quality data at the physician level and cost data that reflect their personal out-of-pocket exposure. These needs will be acute under the coverage expansions inherent in the Affordable Care Act. State and federal policy thus should support all-payer claims databases, standards for electronic health records to facilitate sharing of quality data, and a unified approach to presenting information that prioritizes consumers' needs.
Available from: Kim Dauner
[Show abstract] [Hide abstract]
ABSTRACT: Young adults between the ages of 18-34 are most likely to lack health insurance in the United States. The Affordable Care Act (ACA), a federal statute signed into law in 2010, contains provisions specific to increasing access to health insurance for young adults including the provision that persons under 26 can stay on their parents' insurance. While the reasons for uninsurance among young adults have been documented, how they operate and are perceived on an individual level have not been explored in great detail. Further, it is poorly understood how the ACA policies and the state health insurance exchanges can serve young adults. Thus, we interviewed uninsured young adults aged 18-35 in northeastern Minnesota and northwestern Wisconsin and used inductive thematic analysis to explore these issues. Findings suggest that young adults don't feel at risk for health problems and therefore have low levels of health insurance literacy and place little value on health insurance. Multiple barriers to health insurance coverage, including the provision about staying on a parent's policy, persist despite the ACA. Our findings also suggest valuable lessons for state health insurance exchanges on how to better serve this population. Currently, over 48 million people in the United States lack health insurance (DeNavas-Walt, Proctor, & Smith, 2012). Further, recent research suggests that nearly half of the adult population is either uninsured, experienced uninsurance at least once in the past year, or were not protected from extraordinary out-of-pocket medical costs associated with high deductible individual plans in 2012 (Collins, Robertson, Garber, & Doty, 2013). Close to 25% of those 18-24 and 28% of those 25-34 are uninsured, whereas only 14.7% of the overall population are uninsured (Cohen & Martinez, 2013).
Qualitative Report 01/2014; 19(8):1-15. · 0.22 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: There is significant interest in building the next generation of public reporting tools that will more effectively engage consumers and better enable them to make use of comparative performance information when selecting a provider. Demand for public reporting tools that make health care cost and quality information transparent is fueled by a variety of market forces underway. A host of public reporting efforts and studies have identified a number of challenges, highlighting that, we still do not understand how best to design public reports to meet the needs of the consumer. We identify five areas for additional research that, if addressed, could foster better design and delivery of quality and cost information to consumers.
Medical Care Research and Review 05/2014; 71(5). DOI:10.1177/1077558714535982 · 2.62 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Purpose: To determine the frequency of cost-related information included in patient decision aids (PtDAs) and identify the common modes of presenting cost-related information.
Method: We analyzed published PtDAs found in the Decision Aid Library Inventory (DALI) system, maintained by the Ottawa Hospital Research Institute (N=290). We recorded whether cost was mentioned, how many times, and how it was mentioned and performed descriptive statistical analysis on these data.
Result: A total of 290 PtDAs were anlayzed. A majority of them (n = 161, 55%) mentioned cost in some way, but only 37 (13%) mentioned cost directly by giving a specific price or range of prices.
In addition to the provision of a specific price, cost was mentioned in 8 additional ways: as a benefit (e.g., “[the treatment] is low in cost”), a risk (e.g., “medicines cost a lot”), a “depends on insurance” clause, a statement of predication about insurance (e.g. “insurance usually covers this”), a comparison of costs (e.g., one option is cheaper than another), value and importance of cost (e.g., scale of worry or importance of cost), a suggestion to discuss costs with someone (e.g., physician, social worker, insurance provider), and a suggestion to [vaguely] "consider" cost.
The most common way to mention cost was as a benefit (n = 73, 45%), followed by a risk (n = 54, 34%), depends on insurance (n = 54, 34%), and value and importance to you (n = 48, 30%). 23 of the decision aids that mentioned cost (14%) suggested talking to someone about the costs; of those, 14 suggested a doctor, 3 an insurance provider, and 9 either multiple sources or other.
Decisions about medication option(s) were the type of decision where cost was most likely to be mentioned, with 73% of the decision aids about medication (n = 49) discussing cost in some way.
Conclusion: Whether costs are dicussed in PtDAs is highly variable, as is how they are discussed when they are. Best pracitces are needed for the presentation of cost information. The International Pateint Decision Aid Standards (IPDAS) Collaboration may consider taking on this issue.
The 36th Annual Meeting of the Society for Medical Decision Making; 10/2014
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.