Information key in drive to change employee health care choices

WASHINGTON--Online tools intended to change employees' approach to using health care resources may be subject to misinterpretation, and one employer and its health care plan provider want to make certain employees are not led astray.

The amount of information and how it is displayed affect both employee usage and understanding, say initial findings of a study contracted by the Chicago-based Blue Cross & Blue Shield Assn. of online tools for Wal-Mart Stores Inc. employees across the United States.

The research, conducted by RTI International of Raleigh-Durham, N.C., aimed to identify the information and the presentation that health care consumers found most helpful in making provider selection decisions, said Lauren McCormack, director of RTI's Health Communication Program, during a session at the Business Health Agenda 2007 conference sponsored by the Washington-based National Business Group on Health.

The study, which is ongoing, is part of the BCBS Assn.'s transparency demonstrations that it started in 30 states under its "Blue Distinction" program launched last year.

The demonstrations test the impact of the different communication tools for providing information to plan members on cost and quality, said Jennifer Vachon, executive director of marketing and business strategy at BCBS.

"We are actually testing different ways to put information in front of your employees. What we know is this is incredibly complex, and if we're not putting information out there in a way that is accessible and usable...then we're not going to change behavior," Ms. Vachon said.

"Transparency is the critical enabler when we think about empowering people to make better decisions," Ms. Vachon said. "Consumers are saying they want the information to be able to make decisions (and) they want to be able to make decisions based on actual evidence.

"When information and provider selection tools and quality information is made accessible to your employees, it really does lower the rate of increase in health care costs," she said.

The study that used focus groups, individual interviews, quantitative research methods and statistical analysis found that "people's preferences actually change as they are given information, particularly when it's more complex," RTI's Ms. McCormack said.

If something is not personally relevant, people will dismiss it. They also dismiss it if they don't understand it, she said. "That's why it's critical to make it easy to understand."

For example, many Wal-Mart employees participating in focus groups equated lower volume of a particular procedure with higher quality--just the opposite of what the statistic indicates, said Steve Lampkin, vp of benefit compliance and administration at the Bentonville, Ark.-based retailer.

In addition, the use of symbols such as stars to denote complication rates proved to be confusing. Many employees didn't know if more stars meant that a facility had a high or low complication rate.

"We initially thought that our associates would respond better to symbols, sort of like a Consumer Reports format," Mr. Lampkin said.

Focus group participants also were more interested in quality rather than cost information, Mr. Lampkin said. However, "as we move more and more toward consumer-driven health care...the cost-quality equation will begin to balance out."

Ms. McCormack said information has to be "really clear" to achieve consumer understanding. "If we don't get it right, consumers may dismiss this information, or worse, they make the wrong decision using the information."

She said one of her personal favorites among various study results was nurse-to-patient ratio data for hospitals.

"One person wanted to know if the ratio was during the day or at night," Ms. McCormack said, acknowledging it was a relevant question since hospital staffing generally is lower at night than in the daytime.

Mr. Lampkin said he was surprised by how eager many Wal-Mart associates were to get the information--the more the better in some cases.

"Some wanted high-tech information while others wanted low-tech information," he said. In addition, younger users wanted more data than older users, he said.

Wal-Mart employees also said they preferred customized information, so that they receive only the information that matters to them, personally, Mr. Lampkin said. That might be achieved by analyzing past choices and searches made by employees, he suggested.