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The Burgeoning "Yelpification" of Health Care: Foundations Help Consumers Hold a Scale and a Mirror to the Health Care System

From flashy tech start-ups in Silicon Valley to modernized insurers in New York, everyone wants to “disrupt” health care. In practice, this is immensely more challenging than it sounds.

Electronic health records (EHRs), more than a decade ago, were expected to revolutionize how health information is stored and shared. Yet, even today, 36 percent of office-based EHRs don’t permit secure messaging between patients and physicians, and 37 percent do not even allow patients to view their records.

Instead, we see such sharing happening outside the traditional health care system, through Apple HealthKit and HUGO, mechanisms for people to carry their records in their pocket, on their phone.

It represents a somewhat surprising and growing trend—patients won’t wait and are disrupting health care themselves.

Over the years, a slew of tools have developed to help patients with their health care decisions. Medicare’s Hospital Compare, the Leapfrog Hospital Safety GradeHealthgrades ratings for physicians, and many other tools exist to help direct patients toward high-quality care.

Yet, what is drawing in patients is Yelp—the website widely known for consumer-driven restaurant reviews. Yelp is beginning to play a role in helping patients with their health care decisions. But whether Yelp ratings will drive patients in the right direction—toward high-quality providers—is still unclear.

In an April 2017 New York State Health Foundation (NYSHealth)-funded study, the Manhattan Institute explored the extent to which Yelp ratings of hospitals in New York State correspond to objective outcomes measures across all of a hospital’s patients. The study found that higher Yelp ratings are correlated with better-quality hospitals and can offer consumers a useful, clear, and reliable tool that can be easily accessed. In short, for one very important measure—potentially preventable readmissions—Yelp ratings appear to have a moderately strong correlation with that measure. That is, higher Yelp scores for hospitals are associated with lower readmission rates. These results build on prior evidence that found a similar relationship between Yelp scores and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experience measures for the hospitals in the study.

But while this research has helped to move the needle on validating Yelp as an important asset in the tool chest of health care quality tools, there are still important questions left unanswered.

For starters, do the disparate (and often contradictory) messages from existing rating systems have the potential to help non-savvy patients identify higher quality providers? Or do those messages just lead such patients to throw up their hands in frustration?

Whether Yelp ratings contribute to this potential confusion or help generate greater understanding isn’t clear yet. Indeed, Yelp ratings of hospitals are in their infancy—relatively low sample size over the years and concentration in more urban areas mean that a wait-and-see approach might be best. However, the hope is that consumers’ trust of Yelp as a platform, and the open-ended, more personal nature of reviews, will over time build up into a useful metric of hospital quality.

Both insurers and providers should also explore how user-generated reviews can help them to obtain information about patients with different needs—here, the free-form style of Yelp text reviews can be an advantage, in both understanding what patients value most and what they are most concerned about. Like any observational study, Yelp reviews have their strengths and weaknesses—but their wide availability, and essentially zero cost, make them an attractive tool for researchers who want to better understand how patients and consumers really interact with the health care system.

Yelp also reveals a “secret sauce” for the health care system—that is, in the rush to keep building new health care metrics, we forget that patients want to hear from other patients.

study by Public Agenda, released in April 2017, explored how Americans find and use price information in health care. Funded by the Robert Wood Johnson Foundation (RWJF) and NYSHealth, the study found that the most common sources of information were friends, relatives, and colleagues. Similarly, an Oliver Wyman and Altarum Institute study, funded by the RWJF, found that people turn to friends, family, and patient reviews when choosing a doctor. They trust sources without a financial stake.

And those with a financial stake—health care providers—are also seeing the competitive value to themselves of posting patient-generated reviews and ratings. Northwell Health in New York is now publicly posting patient-generated reviews (both positive and negative) of doctors in its system, as well as scores based on Press Ganey patient satisfaction surveys.

The health care sector views this Yelpification warily. It is why the incorporation of a hospital’s HCAHPS scores, derived from patient experience surveys, into a five-star rating summary that is publicly reported on Medicare’s Hospital Compare consumer website holds such promise and such threat for the health care community. In 2016, the Centers for Medicare and Medicaid Services (CMS) incorporated additional measures into the five-star ratings for Hospital Compare. Read more in this article.

Like any good disrupter, Yelp also exploits a gap in health care information. Current information about health care quality is disconnected from what consumers want.

A study by the New York Academy of Medicine dug into that gap and elicited from a series of focus groups with consumers the following:

“Participants infrequently described using quality indicators commonly utilized by health care professionals, such as procedure volume or infection rate, to make decisions about health care providers. Instead, participants focused on provider communication skills, convenience and credentials.”

An April 2017 study by the American Institutes for Research, funded by the RWJF, California Health Care Foundation (CHCF), and Gordon and Betty Moore Foundation, highlights this disconnect and lays out ways the quality-measurement industry can make quality measurement more patient centered.

NYSHealth is also funding related research by the United Hospital Fund to help move the health care quality-measurement enterprise in New York State toward a more consumer-centric focus. Philanthropy has a role to play in bridging the disconnect.

Already we see a shift, including foundation-funded “shotgun weddings” between the stiff academics and the free-spirit Yelpers.

The CHCF is working with Yelp to post summaries of maternity care quality measures from for each hospital in California that delivers babies. These summaries of maternity care quality measures will appear on the hospital’s profile page on Yelp, alongside Yelp’s user ratings and patient-generated reviews.

These California metrics encompass serious clinical information, the sort that consumers do not typically seek out. This California approach follows the mantra: meet people where they are, even if they are on Yelp.

If that approach is the future, we give it five stars.

This piece originally appeared on Health Affairs


Paul Howard is a senior fellow and director of health policy at the Manhattan Institute. Follow him on Twitter here

Yevgeniy Feyman is an adjunct fellow at the Manhattan InstituteFollow him on Twitter here.

Amy Shefrin is a program officer at the New York State Health Foundation.

This piece originally appeared in Health Affairs