Paying for performance takes on new meaning as consumer reviews generate penalties and bonuses for hospitals and insurers. This could mean a bonus payout of more than $3 billion for insurers and a hold back of $850 million for providers in 2013. The program is known as the Medicare Advantage Star Quality rating system and it relies on consumer input for nearly half of its quality measures. Hospitals and health systems are feeling the pinch as nearly one-third of the federal government's value payment program connects to consumer experience and satisfaction. Moreover, customers support the trend. About half of consumers surveyed by HRI said that customer feedback should affect payments to healthcare organizations.
The Health Research Institute compared and contrasted consumer experiences with other service industries to illustrate existing challenges facing the industry. See how these service industries outside of healthcare are helping shape healthcare consumer experiences and expectations.
Select an industry to compare to healthcare:
As healthcare companies develop new ways to raise their quality scores through improved consumer service, they need to consider how consumers use and contribute to the increasing amount of quality data.
For more information about how the consumer experience is bringing change you may read more here.
The consumer experience matters to healthcare businesses, especially with its connection to financial penalties and bonuses. Private insurers who cover Medicare members were eligible for more than $3 billion in bonus payments in 2012 based on quality ratings.1 The program, known as the Medicare Advantage Five-star Quality Rating system, relies on consumer input for nearly half of its quality measures.2
Hospitals and health systems are feeling the pinch as nearly one-third of the federal government’s value payment program connects to consumer experience and satisfaction. About $850 million, or 1% of total reimbursement in 2013, could be held back as a part of the federal government’s Hospital Value-based Purchasing program.3
Customers support these effects. About half of consumers surveyed by PwC’s Health Research Institute said that customer feedback should affect payments to healthcare organizations. Nearly 70% of consumers have used reviews to make healthcare decisions related to their doctor, hospital, insurance company or pharmacy. And more than 60% said that a hospital’s quality of care affects their healthcare decisions.4
More consumers have read reviews on Consumer Reports and blogs, but consumers are also discovering government-sponsored websites such as the Centers for Medicare and Medicaid Services and the National Committee for Quality Assurance.
One way providers are improving the patient experience is through the patient-centered medical home, which uses the primary care physician as a central point of coordination across the care continuum. All 50 states have medical home efforts, with 44 passing 300+ related laws, and more than 38,000 physicians affiliated with medical homes, an eight-fold increase in the past five years.5 Patients in medical home practices reported higher satisfaction with care, access to care, interpersonal experience, technical quality and communication.6 Success has been attributed to the reduction in bureaucracy, consistency in care, and providing one easy hub for patient health discussions.7
Healthcare organizations are already using positive quality scores as marketing tools. Nearly 40% of Medicare Advantage members are currently served by four to five star health plans, which are the highest ratings available under the bonus program, and the plans with high customer satisfaction scores have increased by 20% over the last year.8 The industry recognize the importance of addressing negative customer input as well. Many companies are taking advantage of social media to address a consumer issue either immediately online or via a follow-up phone call. Nearly 70% of consumers surveyed expected a response to complaints within a day, while 40% expected it within a few hours.9