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Understanding quality in health care

Quality varies widely from one provider’s office to another and even from one doctor’s patient to another. Not all care is equally good. Learn what you can do to find a provider that will help you stay healthy and care for you when you need it.

What is high-quality care?

Good health care is the right care, at the right time, for the right reason. The quality of health care varies, but trustworthy, public information can help you decide what test or treatment is best for you and if the care meets accepted standards.

  • Your doctor should be using the appropriate tests or procedures for your age, gender and medical history.
  • You should get health services when you need them and before you get sicker.
  • You should get health services you actually need, nothing more and nothing less.

Doctors committed to quality will not only welcome your involvement but also encourage it. While your doctor should be able to direct you to reliable information on a health topic that affects you and talk to you about your options, you have a major role to play when it comes to your health and well-being.

How can you get what you need?

Compare care. Finding a good primary care team is the first step in getting high-quality care. Go to the Community Checkup website where you can “shop” for a clinic in your health plan’s network to see how well they rate on quality measures that matter to you. The quality measures that were chosen for this website serve as a proxy for the overall quality of the care delivered by that clinic. For example, even if you don’t have diabetes, seeing how well a clinic is following recommended care guidelines for that disease can signal to you how well they treat any chronic disease.

Make an informed choice. After you’ve looked at options on the website, contact the clinic and ask questions to see if they would be a good fit. Do they offer hours that are convenient to you? Do they accept your insurance? Do the providers have knowledge or specialized expertise in the health areas that matter to you or your family?

Be an active member of your health care team. Do your homework. Go online or use the library to learn more about your condition and treatment options before your doctor’s appointment. Talk to your doctor about what you’ve learned. After your visit, take an active role in your health and health care so you can stay as healthy as you can. Your primary care doctor may tell you to exercise more or eat better, but it’s up to you to follow through on this advice.

Get the right amount of care. Unnecessary care costs money and can be harmful. Patients with chronic conditions do not always get the recommended care. Many people don’t get regular screenings, which can detect disease earlier. Certain drugs, treatments and tests are sometimes offered for common health complaints even though they aren’t really effective. Learn more about the value and effectiveness of specific tests and procedures at Choosing Wisely® patient resources.

Work with your doctor to make decisions about your care. This is sometimes known as “shared decision-making.” It’s important to ask questions, such as:

  1. Do I really need this test or procedure?
  2. What are the downsides?
  3. Are there simpler, safer options?
  4. What happens if I do nothing?
  5. How much does it cost?

While health care consumers have a big role to play in ensuring they get the right care, you are not alone. Providers are the ones ultimately responsible for making sure they are delivering the right care at the right time.

Know you have options. If your expectations aren’t being met, talk to your doctor about your concerns. And if necessary, look for a new doctor.

Quality should be part of the equation for good, high-value health care, as much as patient experience and cost. 

Download the infographic about how to find high-quality care and be a savvy health care shopper.

savvy-shopper-quality-infographic

Infographic: Washington Health Alliance.

This post is second of a series called The Savvy Health Care Shopper. The Washington Health Alliance is partnering with the Washington State Health Care Authority’s Healthier Washington initiative to educate consumers on finding value in health care.

Published: November 23, 2015

About Washington Health Alliance

The Washington Health Alliance is a place where stakeholders work collaboratively to transform Washington state’s health care system for the better. The Alliance brings together organizations that share a commitment to drive change in our health care system by offering a forum for critical conversation and aligned efforts by stakeholders: purchasers, providers, health plans, consumers and other health care partners. The Alliance believes strongly in transparency and offers trusted and credible reporting of progress on measures of health care quality and value. The Alliance is a nonpartisan 501(c)(3) nonprofit with more than 185 member organizations. A cornerstone of the Alliance's work is the Community Checkup, a report to the public comparing the performance of medical groups, hospitals and health plans and offering a community-level view on important measures of health care quality (www.wacommunitycheckup.org).

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