Chapter 4. Establishing Credibility
and Value
Credibility
Establishing the credibility of your coalition
is crucial to recruiting participants and effectively leading a regional
coalition. Achieving credibility means having others recognize the coalition's
capabilities and knowledge.
Business literature identifies numerous
characteristics of organizational integrity, including accountability, honesty,
candor, and transparency. A number of specific factors also affect the
perception of a coalition's credibility, such as its process for data analysis
and validation, how errors are addressed, and what experts and specialties
support the initiative. Coalition leaders have identified the following
approaches to enhancing credibility in the early stages of a coalition among
stakeholders, the media, and the public.
Partner With High-Profile
Organizations and National Initiatives
The Center for Health Information and Research
used its involvement in national projects to help establish its credibility
among major players in the Phoenix area. Its participation in a successful
national quality initiative sponsored by CIGNA, for example, generated local
interest in forming the Phoenix coalition. Partnering with a national human
resources policy association also established its credibility among local
employers. However, convincing large national plans to participate in regional
coalitions can be challenging because their objectives sometimes conflict with
regional goals.
Have Strong Connections Within the
Local and Regional Community
To reinforce its integrity, an emerging regional
coalition also should connect with credible organizations that have strong ties
in the health care and business communities.
Health care community. Minnesota
Community Measurement made a crucial, strong connection with the Institute for
Clinical Systems Improvement, an organization in Minnesota within the physician
and provider community. The institute works with medical groups to establish
quality improvement cultures and infrastructures, including internal
measurement. It also develops guidelines that are based on local and national
best practices and use evidence-based processes. Minnesota Community
Measurement bases its measures on these guidelines, which are approved by local
and regional physicians. Aligning with this highly credible local organization
strengthened Minnesota Community Measurement's credibility among physicians and
providers. The coalition is working to cultivate consumer participation by
reaching out to local organizations that consumers see as credible, such as the
Minnesota chapter of the American Diabetes Association.
St. Luke's Health Initiatives, which helped to
establish the Arizona HealthQuery with the Center for Health Information and
Research in Arizona, also is well connected in the Phoenix health care
community. It was able to draw stakeholders from its many contacts in the
State's hospital and medical associations, the local Quality Improvement
Organization, and the State legislature.
Because it realizes the importance of having
valid and reliable measurements, Massachusetts Health Quality Partners has
established relationships with many world-class health care researchers in the Boston area. Massachusetts Health Quality Partners' credibility benefits from the experts'
involvement in the data analysis portion of the research, and the researchers
benefit from having access to a large, broad-based database.
The California Cooperative Healthcare Reporting
Initiative works closely with the California Medical Association. A California
Medical Association representative sits on the coalition's Executive Committee
and provides perspective on issues that affect physicians. Additionally, the
California Cooperative Healthcare Reporting Initiative also works closely with the
California Association of Physician Groups to enable an efficient communication
path to the physician groups and physician leaders within the State. The
California Association of Physician Groups' medical director sits on the
California Cooperative Healthcare Reporting Initiative's Better Quality
Information Pilot Steering Committee.
Business community. The Wisconsin
Collaborative for Healthcare Quality founders recognized the importance of
building credibility and trust with the business community, a key customer of
each member organization. Each founder invited a business partner to
participate in all the collaborative's meetings, including those focused on
selecting the initial performance measures. Business partners included private
employers, business coalitions, a large union, and a State association of
business and commerce. These invited partners connect the Wisconsin
Collaborative for Healthcare Quality to each local market directly, enhancing
the legitimacy of the collaborative's vision.
The Indiana Health Information Exchange has
cultivated a relationship with the Central Indiana Employers Forum, which
consists of several employers, hospitals, physician groups, and payers. The
forum initiated development of a pay-for-performance quality health program led
by the Indiana Health Information Exchange. Consequently, the coalition
immediately gained the support of important players in the region. The Indiana
Health Information Exchange also worked closely with the Central Indiana
Corporate Partnership, an alliance of chief executive officers from the
region's largest employers and its university presidents. Lastly, the Indiana exchange's board of directors includes hospital chief executive officers, the mayor
of Indianapolis, local public service health care leaders, payers, and other
people needed for ongoing support of the collaborative.
Emphasize the Collaborative Nature
of the Coalition
Providers drive some Better Quality Information
sites; purchasers drive others. Regardless of the driver, keep in mind the need
for underscoring the value exchange's collaborative nature.
For example, professionals with medical
experience drive the Wisconsin Collaborative for Healthcare Quality. This has
given the coalition credibility among clinicians. However, coalition leaders
recognize that to be truly effective, their efforts must be part of a larger
community network. Consequently, purchasers also play a large role in
influencing the direction and governance of the coalition.
Value
The success of a coalition will, in large part,
be based on the value it can provide participants. Each major player in a
multistakeholder coalition brings to the table a different agenda with key
goals and objectives. A critical challenge for coalition leaders is to create
value for each player in order to keep it at the table.
A critical step in forming a coalition and
identifying stakeholders is developing strategies for addressing the "what's in
it for me" motive many will have. Identifying and communicating the value of
the coalition and working to continuously provide that value will be one of the
most important challenges in maintaining a coalition.
Show Value to Entice Participants
To attract purchasers as participants, the
Wisconsin Collaborative for Healthcare Quality emphasized that participation in
the coalition would allow access to comparative performance information that
otherwise would not be readily available. Participation would also allow
purchasers to directly influence the selection of performance measures. As a
result, these stakeholders had an opportunity to improve their business based
on information at their fingertips. This sort of value was an attractive
incentive for purchaser participation, and it was important for the Wisconsin collaborative to highlight this value when inviting purchasers to join.
In addition to access to a rich compilation of
data, one of the most appealing benefits a coalition can offer stakeholders is
saving them time and money through services the coalition provides. When the
Massachusetts Health Quality Partners initially formed, hospitals needed to
respond to multiple requests from health plans for reporting hospital quality
data. Hospitals became frustrated with the number of requests from different
plans, which were redundant and resulted in wasted time and resources and
increased frustration. The Massachusetts coalition was innovative in
coordinating and streamlining the numerous quality data requests into a single
format that all plans accepted. Health plans were satisfied because hospital
quality data requirements were fulfilled in an accurate, concise format.
Hospitals were relieved because now there was one convener—Massachusetts Health
Quality Partners—between hospitals and health plans that alleviated some of the
frustration and wasted resources while ensuring that reporting requirements
were satisfied.
Streamline Complicated Processes
An effective way to demonstrate a coalition's
value to participants is to demonstrate how it will simplify data collection
for them.
The Wisconsin Collaborative for Healthcare
Quality has designed an innovative model of direct data collection from its
participating medical groups. Through the development and application of an
"all payer, all patient" method of measurement, medical groups collect both
administrative and clinical data internally and submit calculated performance
results to the collaborative through a secure, Web-based tool. This method
obviates the need to aggregate administrative data from multiple health plans,
incorporates clinical data for more robust measurement, creates a standard set
of data files for validation and auditing, delivers a ready-made registry for
patient management, and generates a high degree of physician engagement and
support for public reports.
Many years ago, the reporting landscape was wide
open. Health plans were not conducting surveys or requesting much quality data.
However, through quality initiatives and the National Committee for Quality
Assurance requirements, quality reporting flourished, and health plans began
requesting quality data from hospitals. Massachusetts Health Quality Partners
identified a need for coordinating and rationalizing requests from health plans
regarding quality data, and hospitals identified value in the uniformity of forms,
data definitions, measures, timelines, and processes for meeting demands the
health plans were placing on them. In addition, physicians were receiving
multiple statewide preventive care guides from numerous health plans. The Massachusetts coalition consulted with health plans and developed one set of unanimously
accepted guides to be sent to physicians. Both the physicians and health plans
were grateful for this standardization. Being able to recognize the need for
coordination, standardization, and rationalization was an effective strategy
for creating value and should be considered when looking to create value for
stakeholders within your own coalition.
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