Last week the California Office of the Patient Advocate released the newest edition of its 2015/16 Quality Report Cards. The Report Cards provide a tool to assist Californians in comparing quality scores for health plans and medical groups in order to make fully informed health care decisions based on the latest quality data and not just costs. The information includes more than 2,000 clinical data points and patient experience information to help inform their choices. It is available on their website (www.opa.ca.gov) in English, Spanish, and Chinese, and as a downloadable app for smartphone, IPAD, and tablets: (http://www.opa.ca.gov/Pages/MobileApplications.aspx)
The Report Card ratings are based on care that more than 16 million commercially insured consumers received from the state’s ten largest HMOs, six largest PPOs, and more than 200 medical groups. Users can drill-down to see specific plan performance on topics of greatest interest to them, such as diabetes care, checking for cancer, and behavioral and mental health care, and much more.
Q & A on Report Card Release 2015-16
Health Access (HA): What’s new in this release of the Report Cards?
OPA Director Elizabeth “Beth” Abbott (OPA): Starting with this 2015-16 Edition, these online Report Cards now have sorting and filtering features to enable users to compare only the smaller group of plans the consumer has under active consideration, or only the top-rated plans, or the ones available in their county. This information is available through our website at www.opa.ca.gov. This enables the consumer to have information displayed on the screen only the plans or groups that you are choosing between, and not extraneous information.
HA: What is the best feature of the Report Cards that people may not know about?
OPA: In addition to the overall star ratings for health plans and medical groups, you can find some specific ratings regarding some common clinical conditions. For example, if you or a member of your family has diabetes or a respiratory condition or are planning on having a baby, you may want to select a plan or medical group that does an especially good job of delivering that kind of care for those kinds of conditions. Look in the dark blue box on the right side of the first page of the Report Card for what conditions have special data, questions, measures and specific ratings for that condition to evaluate their performance and explanations as to what these measures mean and why they are important.
HA: Last year when you were named OPA Director, you set about to promote the widespread use of the Report Cards and similar tools, knowing what you were up against: Historically, such tools have not been well used by consumers. Recent research by Consumers Union and the Center for Advancing Health suggests consumers would use comparative information (like the Report Cards) if they trusted the source, the information was easy to find, and tailored to meet the audience’s need at a salient point in their health care decision making process—Covered CA open enrollment might be applicable here. What progress have you made over the last year in getting California consumers to actually use the Report Cards when they shop for plans or select a provider?
OPA: We have reached out to consumer organizations, state agencies, industry associations, legislative staff, and in media interviews throughout this last year. We have been particularly focused on other state agencies who use our data. We have asked all these contacts to provide a link to our website on their website, in their newsletters, on their blog. We have conducted webinars for organizations that have clinics, provide consumer assistance, or have chapters or memberships to get the word out about using the OPA website. At the most recent Covered California (the state-based marketplace/exchange) last week, I offered to provide a link to our Report Card to anyone who gave me their business cards—and a bunch of the people present did so, including organizations representing brokers and agents, small businesses, unions and others. We are also reaching out to navigators and certified enrollment entities to make sure their staff and volunteers are aware of the OPA website as a resource.
HA: What lessons have you learned for next year or future iterations of the Report Cards?
OPA: We are now featuring our mobile application because we have found that people can generally be persuaded to check out the star ratings on our Report Cards, but don’t want to install the entire program on their home or desktop computer. The mobile app is free, is downloadable off our website, and can be used easily from wherever people are (find it here: (http://www.opa.ca.gov/Pages/MobileApplications.aspx).
HA: It’s hard enough getting any consumer to use tools like the OPA Report Cards: what is the OPA doing to promote their use among LEP, low literacy audiences, and other diverse groups? Are there plans to report the quality data by race/ethnicity, or any equity data?
OPA: We are making strides to improve our Report Card every single year. The Report Cards are available in three languages (English, Spanish, and Chinese) and for the first time we have done consumer testing as to how understandable our materials are in Spanish. We also did an independent assessment of the literacy level and we are revising some parts of it to be clearer to the average consumer, and moved some policy and research data interesting to mostly academics to separate pages. We are striving to expand the data we are able to display on our Report Cards, but are, of course, limited to what is currently being tracked and that passes our data validation thresholds.
HA: Given that so many California health care consumers do not have a real choice to make—their employer picks the plan for them—to what extent have these Report Cards or the data on which they are based been used by employers and/or unions in California?
OPA: We are trying to make inroads in this area, but we have a ways to go yet. Our tabulation of visits to our site is continuing to grow. We had 119,366 visits to www.opa.ca.gov in 2014, an average of 9947 visits per month. We are pleased to see that our visits to the site for the first two weeks of October 2015 are running 9,358 which is almost twice as many as our monthly average for last year. October is our busiest month because people look at our website in connection with making their health plan choices which begins for many people this month. Although we are not neck-and-neck with fantasy football sites, we are making steady progress in increasing its utilization and our overall visibility. This is true even in unexpected ways. I recently met a professor who teaches health economics at a university in Columbia (Latin America) who uses our OPA website as a textbook for the college course he teaches in health policy in that country.
HA: What can we look forward to in the coming year from the OPA?
There are several things that we are working on now that will be launched soon or in early 2016. We are finishing up our Consumer Health Complaint Baseline Review for 2014 which catalogs complaints across four health agencies in the state (Department of Managed Health Care, Department of Insurance, Covered California Exchange, and Medi-Cal.) We are also taking over the Medicare Report Card for California (a review of performance of health plans that serve people over 65 on Medicare and people receiving Medicare based on disability entitlement). We are also adding information on our Report Card that reflects the cost of health care. It will not list specific costs for services, but give a designation of a composite of total costs with the legend “higher than average costs,” “average costs,” or “lower than average costs.” We want to aid in the understanding among consumers that high costs do not necessarily represent better care. These new initiatives are undergoing consumer testing right now.
HA: Would you like to revisit your long range goal for the report cards?
OPA: Consumers often have some general understanding about some of the up-front costs of their health insurance coverage. This is likely to be true particularly about their premiums, but less so about their out of pocket expenses (deductibles, co-payments, co-insurance when they actually use their insurance.) We find that although consumers understand that the quality of that health care is important, they don’t really know where to find it or how to evaluate it. This is where the OPA Report Cards come into the picture. We use nationally developed standards of what represents quality health care and display it in easy-to-understand language. Our quality data includes clinical data (e.g. regular blood pressure testing or appropriate pre-natal care when you are pregnant) and patient experience (e.g. how easy was it to get an appointment?) We want to have consumers use the Report Cards to evaluate health plans whenever they have to make a selection—and not assume their plan or medical group has the same scores as last year.
OPA is now starting to be asked why some health plans and medical groups are not demonstrating improvement in these quality measurements. Our long-range goal is that we would like to see employers and unions and other purchasers who contract with health plans factor those quality measures into their contracting decisions. In other words, when they are deciding which plans to offer to their employees, they offer them a selection based not only on costs, but what kind of results they get for their patients based on accepted clinical standards and patient experience.
HA: What can community groups do to help promote the use of the report cards?
OPA: I would like this newest information to get the widest distribution possible so it can be used by everyone who wants quality measurement to be part of their criteria when selecting a health care provider or plan in 2015 and 2016. We encourage publication via email, newsletters, blog posts, conference calls and any other communication mechanism you can put to use.
HA: Which groups should help promote the new Report Cards?
OPA: Everyone should make the use of the OPA Report Cards an important, necessary step in selecting your health insurance coverage. This includes your staff, colleagues, affiliates, coalition partners, contractors, customer service center personnel, advisors, navigators, counselors, county staff you work with, press and media experts, and other members of your organization. We regularly get invited to present a quick summary of the Report Cards as part of monthly conference calls or webinars to introduce this tool to groups who are not familiar with it.
HA: What tools are available to community groups to help promote the use of the OPA Report Cards?
The OPA has provided the following tools for community partners to use in promoting the Report Cards.
- A web badge designed for other organizations to place on their websites that will link people directly to the Health Care Quality Report Cards. The html code needed for the web badge placement can be found here: www.opa.ca.gov/Pages/PartnersBadges.aspx. There also are general OPA web badges available in additional languages and sizes that link to OPA’s home page instead of the Report Cards.
- OPA’s social media accounts and links:
Facebook – Office of the Patient Advocate
Twitter – @CAPatientAdv
YouTube – CAPatientAdvocate
- Last but not least, OPA has a “California Health Care Report Card” Mobile App available for free download through iTunes and Google Play. An overview about the Mobile App and the links to the two online stores can be found here: www.opa.ca.gov/Pages/MobileApplications.aspx.