CEO SUMMARY: Once patients become involved in managing their healthcare, they actively seek information that can help them make informed decisions. Health insurers are providing tools to help make this job easier. WellPoint teamed up with Zagat Survey to create the Zagat Health Survey. This unique tool offers consumers a snapshot of a physician from the patient point of view. It is available exclusively to members of WellPoint’s affiliated plans and other participating Blues Plan members.
OVER THE PAST FIVE YEARS, one trend in healthcare has been to encourage consumers to take a greater role in much thought in the choosing their doctors, hospitals, and other providers—even as they are required to pay more money out of pocket. Two elements are required for this trend to succeed.
First, consumers must have easy access to the actual prices charged by different physicians, hospitals, laboratories, and other providers. Second, consumers need a way to determine the quality and service differences among these different providers. These dynamics lie at the heart of CDHPs, (consumer-directed health plans) and HDHPs (high-deductible health plans), including HSAs (health savings accounts) and HRAs (health reimbursement accounts).
Shopping For Doctors
As consumers assume responsibility for managing their own healthcare, they are shopping the Internet for doctors and—much like choosing a hairdresser or restaurant—are making decisions based in part on consumer reviews.
No one in the medical community gave this consumer-driven phenomenon much thought until WellPoint, Inc., the nation’s largest insurer, enlisted Zagat Survey, LLC, a trusted resource of consumer information, to create a consumer satisfaction survey exclusively for its members.
Beginning early last year, WellPoint rolled out the Zagat Health Survey in Southern California, Ohio, and Connecticut. WellPoint plans to eventually expand the tool to all 34.2 million Blues plan members in 14 states. Blue Cross BlueShield of North Carolina, which is not affilliated with WellPoint, also recently contracted with WellPoint to extend the program to its members statewide.
With WellPoint actively promoting the tool online and via direct mail, survey information is building quickly. According to Eric Fennel, Wellpoint Vice President for Innovation, over the last few quarters the volume of consumer feedback on providers has increased exponentially.
In launching the survey, he says the Zagat/WellPoint team involved the medical community market-by-market, including state medical societies. “Some were concerned the survey would only attract the negative, but we were confident that if we positioned it the right way, consumers would respond positively—and they have!” Fennel noted. Consistent with Zagat’s approach in other survey tools, the consumers’ ratings and comments are allowed to speak for themselves. So far WellPoint is pleased with the results.
“The feedback that consumers are sharing with each other has been thoughtful and constructive,” observed Fennel, who noted that more than 75% of patients post comments. Within that total, 85% of patients who post recommend their doctor.
Despite the early evidence that patients are even-handed in their assessments, the idea of being rated by a consumer guide like Zagat has some doctors’ knickers in a bunch. “It is curious that they [WellPoint] would go to a company that had no experience in health care to try to find out how good a doctor is,” said William Handelman, M.D., a kidney specialist in Torrington, Connecticut, to the New York Times. “It certainly is very subjective.”
“As If Preparing A Meal”
Angelo S. Carrabba, M.D., an obstetrician in Rocky Hill, Connecticut, declared that WellPoint’s Anthem Blue Cross and Blue Shield is “treating medical care provided by dedicated and caring physicians as if we were preparing a meal.”
Another sceptic is Arthur Caplan, Director of the Center for Bioethics at the University of Pennsylvania. He is distrustful of open forums for evaluating physician quality. “There is no correlation between a doctor being an inept danger to the patient and his popularity,” declared Caplan, who contended that patient reviews of doctors are “a recipe for disaster.”
The fact that insurers are attempting to rate doctor quality has raised a red flag with some state governments, which are concerned about the motive. Attorney generals and the American Medical Association warn that these programs could direct patients to the cheapest—rather than the best—physicians. The Wall Street Journal reported last fall that the New York Attorney General ordered health plans, including WellPoint’s Empire Blue Cross Blue Shield, to halt or provide more details on their doctor-ranking programs.
Rating Consumer Experience
With regard to the Zagat Health Survey, WellPoint’s Fennel stressed, “This tool looks at consumer experience, not clinical quality.” He suggested that physicians could use the information constructively to make service improvements in their practice.
“The Zagat Health Survey is just one response by Wellpoint to overall consumer desire for greater transparency in healthcare,” observed Fennel. “People value other people’s opinions, but that by itself is not the whole story.” He points out that research indicates consumer surveys are helpful and that the categories surveyed— Trust, Communication, Availability and Environment—are elements of the experience that consumers are uniquely positioned to evaluate.
The Zagat Health Survey is just one part of the consumer transparency effort at WellPoint. It also has a program to provide its members access to the prices charged by different providers. WellPoint’s Anthem Care Blue Cross Blue Shield enables its members to compare costs and outcomes for procedures performed at local hospitals and outpatient facilities.
Cost Comparison Tool
The Anthem Care Comparison tool estimates the cost for the full spectrum of services associated with the procedure at each facility in the region that has a contract with Anthem Care. “The data reflects our actual cost, but doesn’t yet reflect the patient out-of-pocket,” said Fennel. “The goal is to provide consumers with an up- front understanding of the overall costs they are likely to incur. The cost is displayed alongside quality information for each facility, including: frequency or number of procedures, complications, mortality rate and length of stay.”
“WellPoint is also developing a similar member tool for physician quality,” he said. “Ultimately the various types of provider information will be integrated into one display context that consumers use to manage their healthcare.
“The objective is to provide information to members so they understand all the factors needed to make an informed decision about their healthcare and their choice of providers,” stated Fennel. “We want members to be engaged in the healthcare process, and we want to be an objective source of information to support those decisions.”
Lab directors and pathologists can draw several useful conclusions from WellPoint’s efforts to provide more transparency to consumers on provider pricing, provider quality, and patient satisfaction with a specific provider’s service. First, it is now in the second year of working with Zagat on the physician health survey. Consumer response is so positive that WellPoint intends to roll this out to other health plans within its system.
Next, consumers using WellPoint’s Zagat health survey like it. It is another example of how and why the Internet is a great marketing resource. For that reason, clinical labs and pathology groups should be expanding their Web presence and introducing patient-friendly services.
Finally, good or bad, consumers will tell other consumers about their experience, and once posted on the Internet, the critique stays there for a very long time. That is another reason why laboratories should pay attention to patient satisfaction.
How WellPoint Works With Zagat Health Survey
TO HELP CONSUMERS MAKE INFORMED DECISIONS when selecting their doctors, WellPoint engaged the help of Zagat Survey to design and operate what is called the Zagat Health Survey.
The survey tool leverages the familiar Zagat-brand display. It is accessed via WellPoint’s on-line provider directory and at related points. WellPoint members are asked to rate their physicians on four criteria. Members are also asked if they would recommend this doctor to other people. The survey invites members to write comments about their experience and/or explain their physician rating.
Zagat collects and organizes the information. To avoid skewing data, a published doctor rating requires a minimum of 10 submissions. Consumers are only allowed one submission per physician. Each review is screened and inappropriate comments are removed.
The rating scale is 0 to 3, with 3 being excellent; 2 very good; 1 good; and, 0 fair-poor. Consumer scores for a physician are averaged and multiplied by 10 to create the familiar Zagat 0-30-number ratings. The four criteria include:
- TRUST—Is the patient confident in the physician’s approach, integrity and recommendations?
- COMMUNICATION—What about the physician’s bedside manner, responsiveness and rapport?
- AVAILABILITY—Was it easy to make an appointment, was the doctor on time, or the patient kept waiting for hours?
- OFFICE ENVIRONMENT—What’s the condition of the doctor’s office/waiting area, is there reading material, a children’s play area, separate area for sick and well children, and does the staff have a helpful and pleasant attitude?