Patients are defining value in healthcare and we need to accept that

I’ve had a number of discussions recently at the insurer, health system and provider levels about the idea of online patient reviews and while attitudes on the topic are mixed, a few common themes emerged:

1. Insurers and health systems indicate they already have their own provider rating and review tools

2. Providers still have a sense of uncomfortability about being rated and reviewed online

In 2016, Vivian Lee, MD, PH (@vivianleemd) published an article, “Why Doctors Shouldn’t Be Afraid of Online Reviews” in the Harvard Business Review that addressed common misconceptions about online patient reviews. Thus, I will frequently reference her powerful piece to help support my own viewpoints on the subject.

RE: Insurers and health systems already have their own provider rating and review tools

I don’t intend to dismiss the importance of insurers and health systems offering a provider rating and review tool as this tool undoubtedly helps support their own, organizational goals as well as provides patients with the information they need to make informed decisions about their care.

The gap I see, however, is the fact that an insurer or health system owned tool does not necessarily promote a patient centric approach to seeking care. The following are a few questions insurers and health systems can ponder to determine if their existing solution is sufficient:

Does the tool align with the way patients seek care?

For patients that currently receive healthcare benefits through an employer sponsored health plan or Medicare, for instance, I suspect in most cases the patient is searching, first and foremost, for providers that will accept their insurance plan seeing as they will pay more out of pocket to be seen by an out-of-network provider.

So, let’s say a newly employed person receives health insurance coverage through their workplace. In this case, it is likely that this individual will use their insurer’s provider tools to first see which providers are accepting their particular insurance plan. This means that it is less likely that a patient will be typing search terms like, “ABC health system providers that accept XYZ insurance plan” into their Google search bar.

Another factor that may disrupt the traditional ways in which patients seek care are direct-to-consumer, open market healthcare service options that cut out the “middlemen”, which in this case are insurers. Provider rating and review tools must adjust to accommodate these options.

Is the tool unbiased and community driven?

Healthgrades and ZocDoc are great benchmarks as they are unbiased, providing patients with objective information about various providers agnostic of insurance company or health system allegiances, but there is room for improvement.

Serving the needs of specific patient communities is an important aspect of provider rating and review tools that doesn’t seem to have widespread adoption. Evidence from a variety of research studies suggests that the LGBTQ+ community, for example, has particular healthcare needs that are not being met and this community may even have their own definition of what a high quality health experience looks like (e.g. was the provider welcoming and friendly? was the provider competent in LGBTQ+ health issues? etc.).

Does the tool rely on providers and practices to self report? Can they opt out?

Some existing tools rely on providers and medical practices to self report data about their own policies and practices which can translate into low accountability and validation within the patient community. Additionally, allowing providers to opt out of the rating and review scheme conveys, at a system level, there isn’t a commitment to a transparent, patient centric approach to information sharing.

Does tool reflect the entire spectrum of health and wellness services?

The movement towards patients seeking care outside of a standard medical office, either as a replacement of or complement to traditional healthcare services, continues to grow. Thus, the rating and review tools must continue to expand to encompass the entire spectrum of health and wellness services. Sure, I’m seeing acupuncturists and massage therapists listed as options on tools currently, but perhaps we can broaden our criteria to say, “I want to incorporate into my tool any person, place or organization that has a commitment to helping people heal and achieve holistic well-being”. If that wider definition is adopted, things like: ayurveda , diet-based therapies, reiki, gym/fitness facilities, massage therapies, qi gong, and music therapy, to name a few, must be represented.

RE: Providers are still uncomfortable with the idea of being rated and reviewed online by patients

Dr. Lee said it best, “Why is it that as an industry we persist in fooling ourselves that customer satisfaction doesn’t matter? The patient defines value, and the sooner we come to terms with that, the better.  So why hold individual providers, mostly physicians, publicly accountable for delivering an exceptional patient experience? Because it signals to everyone within the organization that it is important and empowers those at the point of care to drive change.”

Using her own experiences at The University of Utah Health Care (UUHC) as a case study, Dr. Lee found that, “by putting patient reviews online, complete with unedited comments and an accessible five-star ranking”, UUHC has demonstrated their ability to: provide better care, build trust with patients, provide safer care, improve margins and drive continuous improvement.

The reality, for health systems and providers who do fear online patient reviews, is that these conversations are already happening! Many marginalized communities, for instance, are using social media channels like Facebook and Twitter to have unmoderated discussions about their health care experiences (though admittedly they are ineffective many times because they are public, disorganized and hard to archive).

Dr. Lee maintains, “for now, patients still defer to word-of-mouth recommendations when choosing doctors and hospitals, and online consumer reviews are like word-of-mouth on steroids. Consumers seek the same support from the internet for health care decisions as they do in other markets — 59% say physician rating sites are “somewhat” or “very” important, and 37% of online review users say they avoided a physician with bad ratings, reports a 2014 study in the Journal of the American Medical Association.”

What if providers shifted their opinions about online patient ratings and reviews from something to be feared to an opportunity to seize? Would this shift in opinion help us progress as an industry towards better, safer, more competent care for all?
Agree? Disagree? Tell me what you think!


LinkedIn: and Twitter:@LaurenCHof

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