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Considering the Confused Healthcare Consumer: Why Less Is More When It Comes to Cost and Quality Data

April 4, 2016
by Mark Hagland
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Researchers find that simplicity of cost and quality data presentation is key

What effect does the presentation of healthcare data have on healthcare consumers? The question is far from an abstract one. Indeed, as CIOs and other healthcare IT leaders prepare with their colleagues to report and publish quality and cost data for a variety of purposes, including value-based purchasing programs, accountable care organization (ACO) and bundled-payment contracting (whether through the Medicare program or through private health insurers), for population health purposes, and any number of other purposes, it will be extremely important for healthcare IT and other healthcare leaders to understand the ways in which data being shared with healthcare consumers is perceived, understood, and used.

A recent study published in the April issue of Health Affairs underscores some of the major challenges in this area. The article, written by Jessica Greene, Ph.D., Judith H. Hibbard, Ph.D., and Rebecca M. Sacks, is entitled “Summarized Costs, Placement Of Quality Stars, And Other Online Displays Can Help Consumers Select High-Value Health Plans.”

Jessica Greene, Ph.D.

As the article’s abstract explains, “Starting in 2017, all state and federal health insurance exchanges will present quality data on health plans in addition to cost information. We analyzed variations in the current design of information on state exchanges to identify presentation approaches that encourage consumers to take quality as well as cost into account when selecting a health plan. Using an online sample of 1,025 adults,” the authors note, “we randomly assigned participants to view the same comparative information on health plans, displayed in different ways. We found that consumers were much more likely to select a high-value plan when cost information was summarized instead of detailed, when quality stars were displayed adjacent to cost information, when consumers understood that quality stars signified the quality of medical care, and when high-value plans were highlighted with a check mark or blue ribbon. These approaches, which were equally effective for participants with higher and lower numeracy”—the ability of individual consumers to understand mathematical and financial data and information presented to them—“can inform the development of future displays of plan information in the exchanges.”

As the authors note in the main text of the article, “We sought to learn from the variation in current presentation approaches in state exchanges to identify the approaches that encourage consumers to consider quality as well as cost when selecting a health plan. This study also advances the literature, which is currently limited and conflicting, on whether or not it is effective to highlight high-value plans and how to refer to them effectively.”

Further, the authors note, “We used two online randomized experiments to test the extent to which the amount of cost information, the labeling and placement of quality stars, and the highlighting of high-value plans influenced consumers to choose high-quality affordable plans. We further examined the extent to which numeracy, literacy, and knowledge of health plan terminology influenced marking high-value health plan choices, and whether there were particular comparative display approaches that supported consumers with relatively low numeracy skills.”

Essentially, what the researchers found was that health plan selection was “highly dependent” on presentation. In other words, precisely what information was conveyed, how it was presented and shared, and how it was framed, was extremely important in consumers’ selections of health plans from a menu of options.

Clearly, there are very strong implications here for the leaders of patient care organizations, as their organizations become more involved in value-based purchasing, accountable care, bundled-payment contracting, and other programs, and especially as healthcare consumers are increasingly pressured by their employers to select high-deductible health plans.

In the context of that landscape, lead author Jessica Greene, Ph.D., a professor and associate dean for research at the George Washington University School of Nursing in Washington, D.C., spoke recently with HCI Editor-in-Chief Mark Hagland regarding the findings of this study, and the implications of those findings, for healthcare IT leaders. Below are excerpts from that interview.

Fundamentally, it appears clear that how information is presented to healthcare consumers has an enormous influence on the choices they make, correct?

Yes, it really makes a huge difference in how data is presented and information is articulated. In addition, my colleagues and I have done similar studies on data from hospitals and medical practices. And the variables are different, but we found the same story, that presentation makes a tremendous impact on how consumers understand the information, make sense of it, and make choices around it.

Please walk me through Experiments 1 and 2, and what you learned from them.