A few weeks ago, we covered the announcement that the soon-to-launch Shatterproof Rating System for addiction treatment programs will go live in five states next year—Delaware, Louisiana, Massachusetts, New York, and West Virginia (see Five States To Pilot The Shatterproof Addiction Treatment Rating System). The system will provide a rating score for addiction treatment for all residential, outpatient, and intensive outpatient programs that are licensed, certified, or otherwise approved by participating states.
The Shatterproof Rating System website will display each program’s rating (which will reflect process or structure quality measures recommended by an expert committee convened by the National Quality Forum) and will also display its accreditation or certifications. Ratings for treatment programs in the pilot states will be free and publicly available on the website and will be searchable by commonly-sought treatment criteria (location, insurance, methods, etc.). The ratings will also be available on password-protected portals for treatment programs, payers, and states, providing more detailed information and data.
The new Shatterproof Rating System joins a growing list of ratings of health and human service stakeholders—health plans, state health systems, provider organizations, and individual clinical professionals. These range from the Centers for Medicare & Medicaid Services (CMS) Star ratings, ratings from accrediting organizations (NCQA, CARF, COA, CQL and others), private rating systems (the Commonwealth Fund, NAMI, World Health Organization, Consumer Health Ratings, HealthGrades, Leapfrog, A.M. Best), and consumer rating systems (RateMD, vitals.com, Yelp, ZocDoc, CareDash, Angie’s List).
Reactions to rating systems in health and human services (not specifically the Shatterproof Rating System) are mixed among provider organization executives. There are concerns about the validity of the rating systems and we have covered some of that criticism (see Medicare Nursing Home Compare Ratings For Overall Facility Performance Not Useful For Predicting Costs Or Readmissions For Bundled Payments and MedPAC Questions Validity Of CMS Hospital Star Ratings).
There are concerns that consumers aren’t aware of rating systems—including The 2019 HealthMine Medicare Survey that found that only 32% of Medicare Advantage plan members with chronic conditions are familiar with the CMS Star ratings system (see Only 32% Of Medicare Advantage Members Are Familiar With Star Ratings In 2019, Up From 22% In 2018: HealthMine Survey). And, critics point out that consumers don’t use rating systems even when they do know about them. The reasons are many, including an inability to understand the report cards or the systems used to deliver them; poor report card marketing; and the lack of “credible” report cards, as judged by consumers (see Why Do So Few Consumers Use Health Care Quality Report Cards? A Framework for Understanding the Limited Consumer Impact of Comparative Quality Information).
But, whether executives like these rating systems or not, or whether the ratings are completely valid, executives of health and human service systems ignore the many rating systems at their own risk. There are two issues. First, the rating systems become the “shorthand” for quality and value. For busy consumers and caregivers, it is a default selection process—think restaurant reviews on Yelp, hotel reviews on TripAdvisor, and movie reviews on Rotten Tomatoes. For payers, it is a means of differentiating between many competing options—and a proxy for quality that can be tied to reimbursement. From a market model perspective, the health and human service system is moving from a “commodity” market (all services by similarly licensed professionals or organizations are the same) to market driven by “value.” Value is a function of cost and performance. And, for better or worse, the rating systems represent the current proxy indicator for performance.
What we don’t know at this point is which of the rating systems will be here in the long-term or will have a lasting impact. But over time the dominant rating systems will shift market share and revenue. The shift in enrollment in the Medicare Advantage plans—74% Of Medicare Advantage Enrollees In Four & Five Star Plans In 2019—is an example.
We’ve covered a wide range of rating systems, ranking systems, and accreditation data over the past few years. For a quick look at the “state of the art,” check out this coverage:
- Medicare Advantage Star Ratings Create New Market Opportunities
- Consumer Star Ratings For Hospitals – It’s Only Going To Get Harder To Earn Those 5 Stars
- Ratings & More Ratings
- Quality Ratings For Health Insurance Plans – Why Do They Matter?
- National Consumer Health Care Ratings Have Arrived
- Succeeding In The Online Ratings Game – Second, You Need A Plan
- Online Ratings Are All Wrong. Consumers Don’t Care.
- Performance Ratings In The Era Of Value-Based Purchasing
- Succeeding In The Online Ratings Game – First, Know The Score
- You’re Being Rated – Like It Or Not
For a first-hand discussion with the people making ratings systems happen, join me on August 14 at The 2019 OPEN MINDS Management Best Practices Institute for the session, “Implementing Provider Rating Scales For Substance Use Disorders: Payer Pilot Results & Impact On Benefit Design”, featuring: Samantha Arsenault, MA, Director, National Treatment Quality Initiatives, Shatterproof; Eric Bailly, LPC, LADC, Business Solutions Director, Anthem, Inc.; and Doug Nemecek, M.D., MBA, Chief Medical Officer – Behavioral Health, Cigna.