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Current policy directions place high expectations on consumers, pressing them to adopt new roles and behaviors. The price of failing to meet these expectations will be high for the individual, for the care delivery system, and for the society as a whole. Yet there is limited support in place to help consumers meet these expectations. The article reviews the major approaches used to stimulate consumer engagement in health and health care. The concept of activation is explored as a possible organizing construct for informing strategies to increase consumer involvement in health. Illustrative data are presented that show how activation levels are associated with engaging in specific health behaviors. The strategy of measuring activation and calibrating both the type and the amount of support for consumers is discussed as a way to improve current approaches. Tailoring activation to the individual, group, and community level is also explored.

Health care report cards have emerged as a new tool to achieve better informed consumer choice and improved health plan performance. With this new emphasis on information dissemination, almost all the attention and effort has gone into the development of valid measures of quality and plan performance. Very little attention is given to the question of what consumers want for making choices or how they will use the measures for choosing health plans. This study uses afocus group methodology and content analysis to explore consumer concepts of quality and to determine how consumers view the quality-of-care indicators that are appearing in report cards. The findings show that consumers have a high interest in quality information. There is a stated preference for quality indicators that reveal how well the plans perform on preventive care and on consumer satisfaction. Asking participants to actually make a plan choice on the basis of comparative plan performance data showed that stated preferences for types of information were inconsistent with actual choices.

In 2011, Fairview Health Services began replacing their fee-for-service compensation model for primary care providers (PCPs), which included an annual pay-for-performance bonus, with a team-based model designed to improve quality of care, patient experience, and (eventually) cost containment. In-depth interviews and an online survey of PCPs early after implementation of the new model suggest that it quickly changed the way many PCPs practiced. Most PCPs reported a shift in orientation toward quality of care, working more collaboratively with their colleagues and focusing on their full panel of patients. The majority reported that their quality of care had improved because of the model and that their colleagues' quality had to. The comprehensive change did, however, result in lower fee-for-service billing and reductions in PCP satisfaction. While Fairview's compensation model is still a work in progress, their early experiences can provide lessons for other delivery systems seeking to reform PCP compensation.

While there has been considerable work to identify ways to make the quality measures contained in comparative reports more understandable and digestible for consumers, there has been almost no research looking at ways to make the overall concept of health care quality more understandable and accessible to consumers. In this study, the authors determine the impact of providing a framework for understanding quality on the comprehension and salience of quality information. The study uses an experimental design and tests the effect of providing a framework for describing quality of care, as well as plain language descriptions of quality indicators. The findings indicate that when providing a framework and using plain language to describe quality indicators, consumers were better able to understand and to see greater value in the information, as compared to participants who saw a report that had neither of these attributes. The policy and practice implications are discussed.

Consumer-driven health plans (CDHPs) are built on the assumption that with increased cost sharing consumers will select cost-effective evidence-based care. In this study, the authors explore whether patterns of utilization change after enrollment in a CDHP and whether the pattern reflects a shift toward evidence-based care. The study population is comprised of 18,025 employees and their adult dependents. The analysis uses a schema for categorizing claims data into high-priority (evidence-based care) and low-priority (limited or no evidence-based care) utilization. The findings indicate that enrollment in CDHPs resulted in a reduction of office visits in the 1st year of enrollment. These reductions in care appear to be indiscriminant, with patients cutting back in both high-and low-priority visits. The reductions in high- and low-priority visits were greater for employees with lower education and income.

Can a well-designed public performance report affect the public image of hospitals? Using a pre/postdesign and telephone interviews, consumer views and reports of their use of public hospital report are examined. The findings show that the report did influence consumer views about the quality of individual hospitals in the community 2 to 4 months after the release of the report.

Objective: This study tests whether a personal narrative can persuade people to value comparative data on physician quality. Method: We conducted an online experiment with 850 adults. One group viewed a cartoon narrative on physician quality variation, another saw text on physician quality variation, and there was a control group. Study participants hypothetically selected a physician from a display of four physicians. The top-quality physician was furthest away and most expensive. We conducted multivariate models examining the relationship between experimental group and choice of the top-quality physician. Results: There was no overall relationship between narrative or text information and choice of the highest quality physician. Among higher numerate participants, however, those who viewed the narrative had odds 2.7 times higher of selecting the top-quality physician compared with the control group. Discussion: Personal narratives can persuade higher numerate people to consider quality when selecting physicians.

Both payment reform and patient engagement are key elements of health care reform. Yet the question of how incentivizing primary care providers (PCPs) on quality outcomes affects the degree to which PCPs are supportive of patient activation and patient self-management has received little attention. In this mixed-methods study, we use in-depth interviews and survey data from PCPs working in a Pioneer Accountable Care Organization that implemented a compensation model in which a large percentage of PCP salary is based on quality performance. We assess how much PCPs report focusing their efforts on supporting patient activation and self-management, and whether or not they become frustrated with patients who do not change their behaviors. The findings suggest that most PCPs do not see the value in investing their own efforts in supporting patient self-management and activation. Most PCPs saw patient behavior as a major obstacle to improving quality and many were frustrated that patient behaviors affected their compensation.

While consumers are increasingly expected to use complex health care information to make informed decisions, it is unclear how many have the skills to do so. In this investigation we examine health literacy, numeracy, and patient activation, assessing the contribution of each to the comprehension of comparative health care performance reports and their use in making an informed choice. A convenience sample of 303 employed-age adults participated in the study. The findings indicate that numeracy skill is the strongest predictor of comprehension, followed by health literacy. Higher activation helps those low in literacy and numeracy compensate for their lower skills and achieve higher levels of comprehension. In addition, making good choices, when trade-offs are necessary, is related to activation separate from comprehension. This is important as many real-life choices involve trade-offs. Results indicate that choice is not just about literacy or comprehension, it also has to do with activation.

Patients have the potential to play an important role in preventing medical errors. Yet little is known about how to effectively engage patients in this role as a "vigilant partner" in care. Respondents were asked to assess the perceived effectiveness of fourteen recommended actions for preventing medical errors. The findings indicate that most of the actions are viewed as effective. However, respondents also indicate that they are unlikely to engage in many of the recommended actions. Having a greater sense of self-efficacy in being able to prevent medical errors is significantly linked with a greater reported likelihood of engaging in preventive action.

As comparative health plan performance data become more available, large employers are increasingly interested in knowing about the value in providing this information to employees to help them choose a plan. The purpose of this study is to empirically examine some of the key assumptions about how disseminating Consumer Assessment of Health Plans Study (CAHPS) report cards may influence employee knowledge, attitudes, and choice. The study used a quasi-experimental design, with preintervention and postintervention interviews with 958 employees. The findings indicate that exposure to the reports is related to having more information on how well the different plans perform on the CAHPS reporting categories. Furthermore, those who saw the report perceive the reporting categories to be more important in health plan choice than those who did not. Finally, the findings show that those who saw the report are more influenced by information sent by their employer than those who did not see the report.