We hear plenty of talk these days about the need to enable consumers to make better health care decisions. Consumers are operating at a distinct disadvantage in the current environment. Health care providers have advanced knowledge gained through years of specialized training and practice, while most consumers lack relevant medical data — a situation economists call “asymmetry of information.”
A new partnership between the California Health Care Foundation and Yelp, the popular San Francisco-based search and review site, seeks to help bridge this information gap. Under the partnership announced in July, Yelp now displays maternity care quality measures for the nearly 250 hospitals that provide maternity care services in California.
This is big news. Yelp has extraordinary reach, especially to Americans of childbearing age. And one in eight babies born in the US is delivered at a California hospital — 500,000 each year. Clinical quality measures on the following key topics are now displayed on Yelp for all California hospitals where babies are delivered:
Vaginal births after cesarean sections (VBACs)
The Yelp ratings are based on data generated by Cal Hospital Compare, a multi-stakeholder nonprofit organization that operates www.CalHospitalCompare.org. The hospital quality website, originally founded by CHCF, has been displaying comparative maternity care quality measures since 2007.
The maternity care data presented on Yelp will be refreshed twice a year. The measures appear on the business listing page of each hospital alongside Yelp’s consumer ratings and comments. The desktop module is live now, and a mobile version should arrive by the end of the year.
A Bigger Megaphone
Childbirth is the number one reason for hospitalizations in the US, so providing access to comparative information about hospital performance is critical. Where a woman receives care can significantly affect health outcomes for her and her baby. For example, the hospital where a woman delivers is a significant predictor of whether she has a c-section. And the c-section rate for first-time, low-risk mothers at California hospitals varies from a low of approximately 16% to a high of over 65%. (Read about CHCF’s initiative to reduce the rate of low-risk, first-birth c-sections.)
Yet too many women remain unaware of this fact and thus don’t seek out comparative information when deciding where to have their baby. Many women and families do, however, turn to Yelp to research a range of consumer services, including medical care.
Lessons Learned About Sharing Information
Research and sometimes painful real-world trial and error have taught important lessons to those of us working to educate consumers about health care data:
Consumers require relevant and actionable information on health care topics. We’ve got to provide health care information about decisions that are “shoppable” — meaning that consumers have the motivation, interest, time, and ability to make a decision.
If you build it, they may not come. Creating a beautiful website doesn’t mean that consumers will flock to it. Hospital rating websites may generate interest from highly educated, research-oriented consumers and professionals, and they can certainly offer a credible threat that encourages providers to improve performance. But unless you’re prepared to invest millions of dollars for sustained advertising to drive consumer traffic, such sites tend to fly under the radar.
Timing is everything. Consumers need access to relevant information when they’re making a decision. In the case of shoppable interventions, this is often long before they are facing their clinician. By combining well-vetted, trusted care quality metrics alongside Yelp’s consumer feedback, the CHCF-Yelp partnership provides a unique opportunity to meet mothers-to-be and their families where they already are on a topic about which they care deeply.
It’s important to point out that some pregnant women may be unable or unwilling to change where they deliver. Perhaps they are enrolled in a plan with a narrow network, live in a remote location with limited options, or really like their obstetrician and don’t want to change even though that doctor is affiliated with a low-performing hospital.
Even in those situations, having the maternity care quality information presented is valuable because it will help consumers gain an appreciation for factors (like c-section rates) that we know are critical to the outcome of their care.
With this information, consumers will also be better equipped to discuss concerns, expectations, and birth preferences with their provider. This will not only spur patients to have richer discussions with their providers, but will go a long way toward addressing the asymmetry of information in maternity care.
Stephanie Teleki is CHCF’s director of learning and impact. She partners with the foundation’s program teams to support organizational learning, evaluate the foundation’s investments, and optimize impact. Stephanie also leads the foundation’s portfolio in maternity care as part of CHCF’s focus on high-value care. This maternity portfolio includes a statewide initiative to lower the rate of unnecessary low-risk, first-birth c-sections; work to improve maternal mental health care; and work exploring the advancement of midwifery care in California.
Previously, Stephanie led CHCF’s transparency-focused efforts to establish and then expand both the California Maternal Data Center and the California Joint Replacement Registry. She also developed projects to track cancer care quality and costs in the state. Prior to joining CHCF, Stephanie was a policy analyst in the health unit of RAND Corporation, where she conducted health policy research and evaluations for such clients as the Agency for Healthcare Research and Quality, the Centers for Medicare and Medicaid Services, the Assistant Secretary for Planning and Evaluation, and private-sector health plans. She has also held research and management positions at Kaiser Permanente, MD Anderson Cancer Center, and the UCLA Center for Health Policy Research. Stephanie received a bachelor’s degree in English and history from Amherst College, a master’s of public health in health services research and policy from the University of Texas at Houston School of Public Health, and a doctorate of philosophy in health services research and policy from the University of California, Los Angeles, Fielding School of Public Health.