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The subject of a quality report could be any level of the health care system, including:

• Health plans and insurance carriers.
• Hospitals.
• Medical groups or clinics.
• Individual clinicians.
• Nursing homes.
• Home health agencies.
• Behavioral health care.

This page reviews the factors that should enter into your decision and suggests some strategies for dealing with complicated scenarios (e.g., reporting on two levels of the health care system at the same time).

Factors to Consider When Deciding Whose Quality to Report

To decide who to focus on, start by considering the five factors below. You will probably need to make trade-offs, in the sense that you may not be able to satisfy all of these criteria at the same time. For example, while a focus on small physician groups may speak to your audience’s interests and support your message, it may be neither feasible nor affordable to gather the data needed for reporting at that level.

Whether consumers can use the report to make a choice. For consumers, comparative quality information is not useful unless it reflects the choices available to them and shows meaningful differences among the compared entities.

Feasibility. Wanting to measure and being able to measure are two different things. The feasibility of measuring and reporting quality depends on multiple factors, including political obstacles, technical challenges, administrative issues, and costs.

Messages you want to convey. The level you focus on should support the messages you are trying to communicate to consumers. For instance, if your report emphasizes the importance of choosing high performers (or avoiding poor ones), you would not want to focus on a level where performance does not actually vary.

Contractual relationships. Contractual relationships are particularly relevant for sponsors that purchase health care services. Purchasers usually want to measure and report on the quality of the organizations with which they contract. However, if you contract with only one health plan, you may want to focus on the quality of the local health systems, hospitals, or medical groups that are available through that plan.

Availability of funds. The focus of your report may be dictated by the amount of money that is available for the quality measurement and reporting effort. If funds are tight, for example, it is more feasible to report data for health plans or hospitals because results are publicly available:

• The National Committee for Quality Assurance’s Quality Compass sells HEDIS data on health plans through its Quality Compass.
• Hospital quality scores are available from both the Centers for Medicare & Medicaid Services and the Joint Commission.

Producing new data at the physician level, on the other hand, may require a significant investment of funds to collect and analyze the data and develop scores

What If You Want Information on More Than One Level?

As you consider the pros and cons of reporting on various levels of the health care system, you may conclude that your audience would benefit from information about more than one subject. Or they may want overall information about one subject as well as details about its components, such as the specialty departments within hospitals.

What can you do?

Report on Multiple Subjects at the Same Time

Some sponsors provide contemporaneous reports on the quality of different aspects of the health care system. This approach helps consumers work through the various decisions they have to make (i.e., which plan to choose, then which medical group to choose). However, this approach requires a large amount of resources in terms of money, staff, and technical expertise.

Examples of reporting at multiple levels:

• :. The OPA offers reports on the quality of health plans and medical groups.
• :  Wisconsin Collaborative for Healthcare Quality offers reports on the quality of health plans, hospitals and medical groups.

Rotate the Subject of Quality Reports

A less resource-intensive alternative is to report on different segments at different times. You can also rotate what you measure each year, e.g., by providing one set of measures in odd years and a second set in even years.

The benefits of this approach are that consumers get information to support more than one decision and that the sponsor’s annual costs are more manageable. The downside is that consumers do not have access to the most recent data. However, some sponsors have noted that the performance of health care organizations does not change that quickly, so consumers are unlikely to miss anything important by getting data every other year rather than every year.

Example of rotating the subject:

• : For the Health Plan Performance Report, the Utah Department of Health rotates the survey sample it uses to collect and report patient experience data for commercial HMO enrollees only. The report presents CAHPS survey results for adults one year, then for children the next.