SITUATION
The non-profit California HealthCare Foundation created the Quality Initiative in 1996 to encourage consumers to consider quality when selecting a health care provider and to introduce quality as a factor that policymakers should consider in the broader health care debate. At the time, health care discussions seemed to revolve exclusively around cost and availability, and as a result, efforts to reform the system lacked attention on quality.

The Quality Initiative retained GMMB to lead an integrated communications campaign emphasizing that:

• When evaluating health care providers, quality is a key element to consider;
  
  
• Quality can include a wide range of measures, including clinical outcomes, value, and patient satisfaction;
  
  
• Quality can be measured fairly and objectively; and
  
  
• Measures of quality can be communicated to health care consumers in a form they can use and understand.

APPROACH
GMMB convened a series of focus groups to evaluate what quality means to health care consumers and to determine how they evaluate quality when choosing a provider. While not surprising, the results showed that a public education was badly needed. Our key findings included:

• Californians had few resources available to objectively measure quality. Our research showed that most Californians chose providers based on insurance company referrals, advice from friends, or advertisements. However, we also found that Californians would enthusiastically consider quality measures when making health care decisions if those measures were available and credible.
  
  
• Health care consumers found existing resources confusing and jargon-filled. Consumers reported an overwhelming preference for simple-to-use tools to measure quality. They were highly suspicious of reports filled with statistical jargon. We tested a variety of methods and found that most consumers preferred the familiar scale of one to five stars.
  
  
• To maximize consumer acceptance, quality information must be generated by objective credible organizations. Consumers were skeptical of information furnished by health care providers themselves.

GMMB worked with the Foundation and its partners to design two major studies providing consumers with practical quality-oriented information they could use to make health care decisions.

• The Guide to California Medicare HMOs was developed in partnership with Consumers Union, the highly respected non-profit publisher of Consumer Reports. The Guide evaluated every Medicare HMO offered in California both for overall value and for prescription drug value. It also provided other measurements of quality, including overall satisfaction and ease of referrals. Following the guidance received from the public opinion research, plans were measured on a scale of one to five stars.
  
  The first Consumers Union Guide was released in August 2001, and new and updated versions were distributed in 2003 and 2003.
  
  
• The Patients Guide to Performance in California Hospitals (PEP-C) was an evaluation of the hospital care, as seen through the eyes of patients. Using a survey instrument designed by the respected Picker Institute, PEP-C measured the patient experience in nine categories or "dimensions" including overall experience, respect for patient preferences, physical comfort, and transition to home. Like the health plans evaluated in the Guide to Medicare HMOs, hospitals were rated on an easy-to-understand star scale.

For both projects, GMMB provided a wide range of editorial services to the Foundation and its partners, designed the reports, and led an aggressive earned media outreach campaign. We also designed and placed a limited advertising campaign congratulating hospitals that agreed to participate in the voluntary PEP-C project.

GMMB relied on a series of proven communications techniques to maximize coverage:

• Go Local. In all our messaging and communications with reporters, we emphasized local angles. We positioned the reports not as statewide monographs, but as local guides with important information for their local audiences.
  
  
• Emphasize Consumer Usefulness. Although the reports raised important public policy questions, we presented them as a tool that consumers could use to find a quality health care provider. We hoped to frame the report as a consumer story, not a policy one.
  
  
• Take the Story to Reporters. We used a variety of techniques, including satellite media tours and audio news releases, to bring the Quality Initiative story into newsrooms. To minimize the effort required by reporters, we did not hold a formal press conference, but relied instead upon a totally remote strategy.

RESULTS
Media coverage for the launches of all three studies was extensive, in both the print and electronic media. The projects were covered in virtually all of California's most important newspapers and appeared on the front page of several major dailies. The projects received also strong editorial support from a variety of papers including the Los Angeles Times and The Sacramento Bee. Coverage was also strong in the electronic media, generating dozens of television reports and hundreds of radio stories.

In total, each release GMMB managed for the Quality Initiative generated between eight and ten million audience impressions.

The media coverage clearly reached its intended audience, as the Foundation's toll-free publication request line was overwhelmed with requests for the reports. Demand was so strong that we were forced to reprint the Medicare HMO guides within weeks of their first release. GMMB's communications campaigns also generated record traffic and download requests on the Foundation's Web site.