Rethinking the enemy
For years, health care providers have shot daggers at the mention of third-party online sites that purported to compare the merits of one provider with the next.
As the consumer movement takes hold, however, some health systems and physician groups are calling a truce. Louisiana’s Ochsner Health System this summer partnered with Healthgrades, the largest of the online rating sites, to enable consumers to book real-time online appointments with Ochsner physicians who use the Epic electronic health record. Before they check out a physician’s appointment calendar, consumers can compare physicians on procedures performed, conditions treated, years in practice, insurance information, malpractice and sanctions and how other patients have rated their experience.
The emerging collegiality reflects the fact that provider organizations realize consumers are shopping for health care services online — and online shoppers like to click through to make a purchase while they are on a site.
“People understand today that there should be information available to them in health care, so they have the expectation that health care sites online should give them the same ease that Expedia gives them,” says Andrea Pearson, executive vice president for consumer products at Healthgrades.
Of course, not every one of the more than 30 million consumers a month who visit Healthgrades or the 10 million who visit Vitals, the second-biggest player, leaves a provider rating, but as traffic grows, so do the number of ratings posted on the sites.
“We’re both getting a lot of ratings these days, and we’re both getting critical mass,” says Mitch Rothschild, executive chairman and founder of Vitals.
The sites define “critical mass” as the number of ratings needed for a consumer to consider the information to be meaningful, rather than anecdotal. Vitals’ research suggests that critical mass means at least nine ratings for a provider; Healthgrades thinks it’s about 10. Once they hit their respective numbers, they believe the ratings are as useful for health care shoppers as TripAdvisor is for travelers.
Each online rating site has its own priorities for transparency and strategy for collecting data. For example, Rothschild describes his company as “a very large vacuum cleaner” that collects and aggregates data — board certifications, procedure volumes, mortality rates for surgeons, awards, referral patterns, HCAHPS and Healthcare Effectiveness Data and Information Set measures and more — from public sources. That information is displayed along with consumer ratings about patient experience.
Providers have a lot of complaints about the review sites: They attract only disgruntled patients; ratings and comments may not be from actual patients; supposedly factual information is outdated or inaccurate. Regardless, with more than 40 million consumers clicking into the reviewing sites each month, their potential impact is hard to ignore.
“The airlines for many years refused to show the seating charts or the prices, until Priceline and Travelocity started providing that information,” Rothschild says. “We have on our board the ex-CEO of Priceline and an executive from Open Table. So, we are trying to model our company after them.”
The ability to compare by cost and quality
The transparency movement means that the sites need to provide comparative cost information, and that is coming. Healthgrades expects to incorporate cost information within the next year, and Vitals is already the behind-the-scenes power for health plan tools that help members make health care purchasing decisions. Using information about a member’s plan benefit design and deductible status, the tool can estimate a patient’s out-of-pocket responsibility for a given service delivered by a specific provider.
“In addition to how long you’re going to wait before you see that doctor, we report the wait times other people have had, what patients think of them, their board certifications, how many other people recommend the doctor — and you can book online,” Rothschild says.
Some health plans use the tool to help their members shop on both cost and quality. Those plans use a tiered benefit design that financially incentivizes a member to choose a lower-cost facility to receive a magnetic resonance imaging scan — and use the Vitals tool to highlight how much he or she will save by doing so.
“This is the idea of transparency: showing what is available, and then helping people to understand the economics and quality consequences of the decisions they make,” Rothschild says.
Healthgrades CEO Roger Holstein forecasts that three on-the-rise phenomena — high-deductible health plans, public and private insurance exchanges, and narrow networks — will fuel the demand for transparency. “You’re going to have consumers demanding the right information. You’re going to have large employers demanding it. You’re going to have federal and state governments defining the requirements [for narrow networks] and, as a result, all of that is going to require transparency,” he says. And that will cement the role of third-party transparency providers like his in the health care industry. — Lola Butcher •