May 2007

Grant Results

SUMMARY

From 2004 to 2005, staff at the RAND Corporation developed a framework for a Web-based tool to help patients understand the quality of health care they are receiving and provide them with information to obtain additional health care services.

Key Results

  • The project team designed a Web-based tool that would allow patients to assess the quality of their health care and take steps to receive necessary care.
  • The team created a prototype of the tool to demonstrate its capabilities and features.
  • The team defined four potential business models to develop and sustain the health care quality tool and explored the possibility of a partnership with a variety of organizations, but did not reach agreement with any of them.

Funding
The Robert Wood Johnson Foundation (RWJF) provided $74, 231 to support this unsolicited project.

 See Grant Detail & Contact Information
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THE PROBLEM

In the June 26, 2003, issue of the New England Journal of Medicine, a team of researchers led by Elizabeth A. McGlynn, Ph.D., of the Rand Corporation, reported findings from the Community Quality Index project, an examination of the level of health care quality in the United States.

(The Index project, funded by a series of RWJF grants — ID#s 032809, 033095, 034940 and 040829 — is part of the larger Community Tracking Study conducted by the Center for Studying Health System Change.)

McGlynn's team conducted telephone interviews in 12 metropolitan areas and examined medical records to determine the quality of care respondents received for 30 acute and chronic conditions, as well as preventive care. Findings included:

  • Survey participants received 54.9 percent of recommended care for their conditions.
  • Quality varied substantially for different medical conditions, ranging from:
    • 78.7 percent of recommended care for senile cataracts, to
    • 10.5 percent for alcohol dependence.
  • There was little difference in the quality of care received for preventive health, acute and chronic care.

The paper received widespread press attention making the public aware that there was likely a gap between the care they needed and the care they received. In response, the researchers at RAND began to receive inquires from patients asking how they could determine the quality of the care they were receiving.

Unfortunately, none of the materials for the Community Quality Index project was designed to help individual patients assess their medical needs and compare them to their current level of health care, according to the project director, nor were there existing Internet tools that offered the types of information for which consumers were asking.

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THE PROJECT

This RWJF grant funded McGlynn and other researchers at the RAND Corporation (a think tank providing research and analysis on a range of social and economic issues, located in Santa Monica, Calif.) to explore the feasibility and design for an Internet tool or set of tools that would help patients assess their care and seek out services they need but are not receiving. Specific objectives were to:

  • Design a framework for a Patient-Centered Quality Scorecard.
  • Develop a prototype of a portion of the scorecard to test the concept's feasibility.
  • Evaluate the potential market for the scorecard.
  • Identify options for a business model to support the scorecard over the long term.

If this work suggested that the scorecard was both technically and economically feasible, the project team would draft a proposal for full development of the scorecard.

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RESULTS

The project team reported the following results to RWJF:

  • The team designed a Web-based tool that would allow patients to assess the quality of their health care and take steps to receive necessary care. The tool's content is comprised of information from three quality measurement systems developed at RAND:
    • QA Tools (a comprehensive clinically detailed method for evaluating the extent to which people are receiving evidence-based care for the leading causes of death and disability as well as preventive measures).
    • Assessing Care of Vulnerable Elders (ALCOVE) quality measures (a quality-of-care assessment system for older persons).
    • Arthritis Foundation's Quality Indicator Project (quality measures to improve the quality of care for people with arthritis).

      Combined, these measurement sets span 35 health care conditions and preventive care with 350 quality measures that are relevant to adults, including vulnerable elders. The tool queries consumers for information regarding the quality measures that pertain to them and integrates patient information so it is obtained only once from the consumer.
  • The team created a prototype of the tool to demonstrate its capabilities and features. The "Health Help" prototype simulates the operation of the tool based on two sample patients. (The prototype is not publicly accessible, but the project director can provide temporary access upon request.) (See the Bibliography for details.)

Marketing Efforts

The project team defined four potential business models to develop and sustain the health care quality tool:

  • A subscription-based product for use by employers, insurers, provider groups, health systems or consumer health Web sites such as WebMD or AOLHealth.
  • Sponsorship by a not-for profit public interest group(s) and/or government agencies.
  • An independent Web site with revenue from advertisers.
  • An exclusive licensing agreement with an established search engine company.

See the Appendix for more details on these models.

The team engaged in discussions with leaders from a variety of organizations to assess their interest in forming a business partnership to develop the tool, including:

  • a health insurance company.
  • a staff-model HMO.
  • two patient advocacy groups.
  • an Internet search engine company.
  • a Web-based provider of medical information for consumers.

Each organization, with the exception of the Internet search engine company, expressed significant interest in the tool. However, they were generally unwilling to discuss a possible business partnership until a fully developed tool was available for use. The most promising discussion was with WebMD, an online provider of health information services to consumers, physicians, health care professionals, employers and health plans.

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AFTER THE GRANT

A possible partnership between RAND and WebMD did not materialize because RAND could not find a funder to support its share of the cost of developing the full Web tool. The project team continues to seek funding to fully develop the tool and test its effectiveness. In an interview, the project director said the most likely scenario would be a partnership with a health insurance plan, in which case the tool would be available only to members of that health plan.

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GRANT DETAILS & CONTACT INFORMATION

Project

Developing a Patient-Centered Quality Calculator

Grantee

Rand Corporation (Santa Monica,  CA)

  • Amount: $ 74,231
    Dates: February 2004 to August 2005
    ID#:  049838

Contact

Elizabeth A. McGlynn, Ph.D.
(310) 393-0411
McGlynn@rand.org

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APPENDICES


Appendix 1

Proposed Business Models

The project team developed four potential business models and related marketing plans:

  • Business Model One: Subscription-based for use by employers, insurers, provider groups, health systems or consumer health Web sites such as WebMD or AOLHealth.
    • Sponsors pay a subscription fee for their employees/members to access the tool. Use of the tool is free to individual users. The tool could be hosted at RAND or at a server maintained by the subscriber.
    • Advantages of this model include:
      1. a self-sustaining revenue source that can be used for updating and improving the tool
      2. access for health care consumers and people who already use the Web to find health-related information.
    • Disadvantages of this model include:
      1. potentially restricted access to the general public, as only members of the subscriber organization would have access to the tool
      2. the potential for actual and/or perceived associations between the tool and commercial entities, such as the subscriber and other entities that may advertise on the subscribers' Web site.
    • The marketing for this model consists of the subscriber marketing the tool to its members. The tool would not be marketed to the general public as the subscribers paid for the opportunity for its members to use the tool.
  • Business Model Two: Sponsorship by a not-for profit public interest group(s) and/or government agencies.
    • Foundations, patient advocacy groups or government agencies fund the ongoing hosting and maintenance of the tool. RAND physically hosts the tool and it is accessible to the general public.
    • Advantages of this model include:
      1. the potential for reaching a large number of health care consumers, as there are no barriers to accessing tool, such as a subscription fee
      2. RAND retains control of the content and has easy access to update the tool
      3. the site will be viewed as a credible source because RAND is considered a neutral source of quality information.
    • Disadvantages of this model include:
      1. the long-term funding source may not be certain, as foundations, advocacy groups and government agencies may change the focus of their funding
      2. increased marketing activities are necessary to attract users to the site.
    • The marketing for this model consists of attracting Web traffic through search engine placement, strategic linking with sponsoring organizations and advertising via sponsoring organizations' publications.
  • Business Model Three: Independent Web site with revenue from advertisers.
    • The tool exists as an independent Web site accessible to the general public for free. Revenue is generated from advertisements on the site.
    • Advantages for this model include access to the general public and a potential revenue stream to fund the operation and maintenance of the site.
    • The primary challenges with this model are:
      1. ensuring people use the tool to make it feasible for sponsors to advertise on the site
      2. securing contracts for advertising.
    • The disadvantage of this model is that consumers may view the tool as less credible because of advertisements on the site.
    • The marketing for this model consists of attracting Web traffic through search engine placement, strategic linking purchased from sponsors and purchased advertising in Web and print publications.
  • Business Model Four: Exclusive licensing agreement with an established search engine company.
    • The tool is licensed to an established search engine company (e.g., Google, Yahoo) and is accessible to people using that search engine.
    • Advantages for this model include:
      1. a steady revenue stream for the operation and maintenance of the tool
      2. broad access to the general public.
    • Perceived advantages for the search engine company include:
      1. providing a public service that could enhance the company's public image
      2. providing a service that is valuable to users of the engine could increase user loyalty and drive additional users to the search engine
      3. providing a service for which the search engine could generate additional advertising revenue.
    • Like business model three, the primary disadvantage for this model is that the tool might be viewed as less credible by consumers because of advertisements.
    • The search engine company markets the tool.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

World Wide Web Sites

http://web3.rand.org/health/rwj. "Health Help Prototype." This site may be viewed for a 24-hour period by contacting the project director. Santa Monica, Calif.: RAND Corporation, 2005.

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Report prepared by: Barbara Matacera Barr
Reviewed by: Robert Narus
Reviewed by: Marian Bass
Program Officer: Maureen Michael
Program Officer: Stephen Downs