The HEDIS 3.0 MSS is analyzed for key drivers of member satisfaction with health plans.

Today's environment of health plan choice requires better understanding of how plan attributes other than price influence plan choice, how other variables such as health status interact with plan attributes in the decision-making process, and how specific populations differ from one another in terms of the sensitivity of their health plan choices to these different types of variables.

Comprehension of Quality Care Indicators: Differences Among Privately Insured, Publicly Insured, and Uninsured.
Jacquelyn J. Jewett and Judith H. Hibbard
This study explores consumers' comprehension of quality indicators appearing in health care report cards. Content analyses of focus group transcripts show differences in understanding individual quality indicators and among three populations: privately insured; Medicaid; and uninsured. Several rounds of coding and analysis assess: the degree of comprehension; what important ideas are not understood; and what exactly is not understood about the indicator (inter-rater reliability exceeded 94 percent). Thus, this study is an educational diagnosis of the comprehension of currently disseminated quality indicators. Fifteen focus groups (5 per insurance type) were conducted with a total of 104 participants. Findings show that consumers with differing access to the experiences with care have different levels of comprehension. Indicators are not well understood and interpreted in unintended ways. Implications and strategies for communicating and disseminating quality information are discussed.

Condition-Specific Performance Information: Assessing Salience, Comprehension, and Approaches for Communicating Quality.
Judith H. Hibbard, Shoshanna Sofaer, and Jacquelyn J. Jewett.
This study assesses how consumers view condition-specific performance measures and builds on an earlier study to test an approach for communicating quality information. The study uses three separate designs: a small experiment, a cross-sectional analysis of survey data, and focus groups. We test whether providing information on the health care context affected consumer understanding of indicators. Focus groups were used to explore how consumers view performance measures. The cross-sectional survey analysis used survey data from the experiment and the focus groups to look at comprehension and the salience of condition-specific performance measures. Finding show that a general consumer population does view condition-specific performance measures as salient. Further, the findings provide evidence that information on the health care context makes a difference in how consumers understand performance measures.

Consumer Information Development and Use.
Lauren A. McCormack, Steven A. Garfinkel, Jenny A. Schnair, A. James Lee, and Judith A. Sangl.
The availability of informational materials to aid consumers in making health care purchasing decisions is increasing. Organizations developing and disseminating these materials include public- and private-sector employers, providers, purchasing cooperatives, State agencies, counseling programs, and accreditation bodies. Based on case study interviews with 24 organizations, we learned that 10 included consumer satisfaction ratings and performance measures based on medical records. An additional four organizations developed materials with consumer satisfaction ratings exclusively. Printed materials were the most common medium used to convey information to consumers. However, other mechanisms for conveying the information were also employed. On the whole, the materials have not been rigorously evaluated. Evaluations are needed to determine if consumers find the information useful and how different individuals prefer to receive the information.

Consumer Perspectives on Information Needs for Health Plan Choice.
Deborah A. Gibbs, Judith A. Sangl, and Barri Burrus
The premise that competition will improve health care assumes that consumers will choose plans that best fit their needs and resources. However, many consumers are frustrated with currently available plan comparison information. We describe results from 22 focus groups in which Medicare beneficiaries, Medicaid enrollees, and privately insured consumers assessed the usefulness of indicators based on consumer survey data and Health Employer Data Information Set (HEDIS)-type measures of quality of care. Considerable education would be required before consumers could interpret report card data to inform plan choices. Policy implications for design and provision of plan information for Medicare beneficiaries and Medicaid enrollees are discussed.

Employer-Specific Versus Community-Wide Report Cards: Is There a Difference?
David J. Knutson, Jinnet B. Fowels, Michael Finch, Jeanne McGee, Nanette Dahms, Elizabeth A. Kind, and Susan Adlis.
This article describes preliminary results from a natural experiment that tested the impact of report cards on employees. As part of the 1995 enrollment process, some members of the State of Minnesota Employee Group Insurance Program received report cards on the plans offered to them, and others did not. Both groups of employees had a chance to review a second community-wide report card covering all Minnesota plans that had been distributed by an independent organization through local newspapers. Both groups were surveyed before and after they made their health plan selections. We compare the likelihood of seeing, the intensity of reading, and the perceived helpfulness of the first, employer-specific report card with the second, community-wide report card for consumers who make plan selections.

Role of Consumer Information in Today's Health Care System.
Judith A. Sangl, Michael McMullan, and Linda F. Wolf.
This overview describes several trends promoting more active consumer participation in health decisions and how consumer information facilitates that role. Major issues in developing consumer information are presented, stressing how orientation to consumer needs and use of social marketing techniques can yield improvement. The majority of the articles published in this issue of the Review discuss different aspects of information for choice of health plans, ranging from consumer perspectives on their information needs and their comprehension of quality indicators, to methods used for providing such information, such as direct counseling and comparative health plan performance data. The article concludes with thoughts on how we will know if we succeed in developing effective consumer health information.

Role of Information in Consumer Selection of Health Plans.
Francois Sainfort and Bridget C. Booske
Considerable efforts are underway in the public and private sectors to increase the amount of information available to consumers when making health plan choices. The objective of this study was to examine the role of information in consumer health plan decisionmaking. A computer system was developed which provides different plan descriptions with the option of accessing varying types and levels of information. The system tracked the information search processes and recorded the hypothetical plan choices of 202 subjects. Results are reported showing the relationship between information and problem perception, preference structure, choice of plan, and attitude towards the decision.

The findings indicate that items with which members are least satisfied (access to doctors after hours, office waiting time, and time for routine appointment) do not predict either satisfaction with access to care or satisfaction with quality of care. No differences between employer-group members and non-company members.

This study assesses the relationship between the salience of quality information and how well it is understood by consumers. Poorly understood indicators are viewed as not useful. Consumers often do not understand quality information because they do not understand the current health care context. All of this suggests that salience alone is not sufficient to determine which indicators should be included in report cards.

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