States and other stakeholders are developing public-facing healthcare price and quality tools to help consumers navigate the healthcare marketplace. Some proponents expect these web-based tools will drive value in the health system by enabling consumers to make informed choices about where and from whom they receive care. Many transparency tools have been launched in recent years (by state entities and insurers) and a variety of stakeholders are eager to learn which tools are best. This has led researchers at organizations such as New York State Health Foundation, Consumer Reports and Altarum to evaluate these tools for their functionality and usefulness.
This study employed a unique approach designed to emulate consumers’ real-world experience of trying to schedule needed healthcare. Using six common, non-emergency medical scenarios, we tested six highly ranked healthcare transparency tools (see Table ES-1 on page three of the full report) with real consumers and evaluated their ability to navigate the tools to get desired information.
The findings reveal a deep divide between the information that consumers would typically seek and the information provided by the transparency tools. Moreover, our cognitive interviews revealed that consumers would not typically turn to a web-based comparator tool to select a provider. Indeed, many were surprised to learn that tools like the ones tested in this exercise even existed. Instead, they would ask friends, family, use Google and call their insurance plan (if the person had insurance) to get needed information before scheduling a procedure.
While a few of the tested tools received high marks from the consumers, for the most part, the tools did not emphasize the type of information that patients most desired. Cost, for example, was not typically a key attribute for our insured participants. People generally thought that price depended upon what insurance they had but did not realize that prices can also vary among providers. In order to determine the price of a service, participants told us they would call insurance companies (if insured) and providers. Their primary goal was to obtain an estimate of the out-of-pocket cost, not to compare prices. These sentiments help explain why the ability to search for prices is not high on consumers’ list of desired attributes for transparency tools.
All participants emphasized that information on physician attributes was of key importance when seeking care. Specifically, they wanted to know:
On these attributes, the tools we tested were mixed. All tools included facility location information but only three tools provided physician location information. No tools provided physician attributes like photo, earliest appointment or other information that consumers desired.
The key quality attributes that interested our interviewees were customer service, a provider’s “bed-side” manner and friendliness of physician and office staff. In general, the tools fared well on these dimensions, with all six providing some form of patient experience data, although it was somewhat ambiguous to participants what the term “patient experience” meant. With respect to variation in clinical quality, participants expected providers to be relatively consistent. This stemmed from the belief that non-emergency medical procedures were fairly common and presented little risk of a poor medical outcome.
To the extent they were inclined to use cost or quality information, our participants expressed a preference for seeing this information side-by-side. Americans are now used to shopping for a wide variety of goods and services online and have well-developed approaches to how to assess value. Our interviewees told us that, in general, they are willing to accept a slightly lower quality rating for a dramatically lower cost. Though they generally had not seen quality ratings for medical care, the interviewees indicated that they would take less than perfect ratings “with a grain of salt,” given that most people do not like having to receive medical care. Because of this, perfect ratings raised suspicions, slightly above average ratings were not interpreted negatively, and only extremely low ratings raised red flags.
The diversity of approaches to price and quality transparency tools, low consumer uptake and the fact that a variety of rubrics have been used in prior scoring efforts suggests there is still much to learn about successful design of, and role for, these tools. This study finds major gaps in how consumers approach scheduling non-urgent medical care and the type of information offered in highly ranked healthcare transparency tools. The findings also suggest a path forward. The strongest parts of existing tools can be emulated by other tools; strong adherence to user-centered design can increase consumers’ trust and use of the tools; and, by making the most sought-after information prominent (e.g., physician attributes), tool designers can help connect consumers to corollary information on price and quality.
Price and Quality Transparency Tools: A Checklist for Advocated, Tool Designers and Policymakers (Click here for a version of the Checklist with a list of cited sources)