Families typically spend more on health care than on any other product. Yet today’s ratings culture with its stars, grades, and scores on everything from hiking boots to mountain villas has yet to establish credible, easy-to-use quality guides for doctors, hospitals or health insurers.

Consumers have never had as much at stake in the health care system and can’t afford to make the wrong choices because they lack the right information. A growing number of people with insurance today are moving into high-deductible plans that put the purchasing pressure on the consumer. Now, with the Affordable Care Act (ACA) about to steer millions of newly-insured Americans into marketplaces known as exchanges, government and industry need to collect and distribute real-time patient feedback that offers viable quality and experience comparisons.

Patients’ yeas or nays already add up in this era of value. The ACA has shifted reimbursement policies toward quality, moving from fee-for-service to outcomes-based payment. Insurers that serve Medicare beneficiaries stand to gain at least $5 billion in bonus payments linked directly to patient feedback. Medicare also rewards hospitals that provide high-quality care through its Hospital Value-Based Purchasing Program. Aside from the financial benefits, providers and insurers have much to learn from seeing how they rank across the competition.

For consumers, however, word of mouth still trumps reviews and ratings. PwC’s Health Research Institute (HRI) surveyed 1,000 consumers in late 2012 and found that nearly half (48 percent) read a multitude of reviews, but only one-third acted on those ratings in health care decisions. At the same time, about half said they want payment policies to be tied to their feedback.

Industry leaders interviewed by HRI attribute the slow uptake of health care reviews to several factors:
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  • Overload of information. Deciphering the myriad of health care ratings and the high volume of chatter on blogs and Internet forums can be a daunting experience.
  • Personal relationships outweigh individual reviews. Consumers rely on social relationships with advisors, especially doctors, for important health care decisions.
  • Perception of “no choice” in health care. Individuals believe they don’t have the right or ability to choose.
  • Need for trusted source of reviews. The health industry lacks a commonly accepted, widely known source of reviews.

The health care industry has yet to fully realize the benefits of real-time reviews, from attracting new customers to implementing quality improvements that can boost the bottom line. Other industries, including travel sites, restaurants and online retail giants have developed trusted networks of reviewers that constantly feed the decision-making process for consumers.

The gap is being slowly filled. Consumer Reports, identified by 43 percent of HRI respondents who have read reviews as a source of information, moved into health care to “level the playing field” for everyday citizens who are inundated with ads and promotions, rather than facts, said John Santa, MD, who directs the Health Ratings Center there.

Formed in 2008, Consumer Report’s Health Ratings Center has published ratings on drugs, hospitals, health insurance, doctors, and diseases and preventive services in a way that can resonate with average readers. Six to seven percent of their readers surveyed said they had plans to change hospitals after reading its recent hospital safety ratings story.

Santa says that’s a step in the right direction. “The goal is to fundamentally change market behavior.”

Consumers are beginning to demand more transparency and the health industry may see a boost in ratings use once health insurance exchanges go live in October. Each state is required to have quality ratings and customer satisfaction information with comparisons of health plans offered on the exchanges. People’s first contact point with the exchange — called “navigators” — must become better informed, since these state-chosen insurance brokers or non-profit organizations are tasked with guiding consumers through the enrollment process. Over the long term, consumers will likely demand health care navigators with much broader portfolios, in the same way we rely on financial advisors for a host of information.

Well in advance of exchange enrollment season, several health care organizations have begun promoting transparency and ease of use. California HealthCare Foundation’s “Free the Data” initiative aims to make information more broadly accessible as a one-stop shopping site for state health care quality and experience information. The Leapfrog Group has developed a Hospital Safety Score that allows consumers to compare hospitals across 26 safety measures, such as receiving the correct antibiotic, hand hygiene, or foreign objects being left inside the body after surgery. Employers are also getting in the game by providing cost and quality data on health plans to their workers.

Other health care organizations incorporate customer feedback into continuous improvement. Minnesota-based Mayo Clinic uses patient surveys to raise awareness of physicians and mid-level providers in areas that include clarity of communication and empathy. At Kaiser Permanente, employee bonuses are partially tied to acting on patient feedback. Retail companies such as Walmart have directed their consumer focus to improve patient experience in its pharmacies.

Clearly, ways exist to tap the power of customer ratings in health care. We know that consumers want information that is relevant to them: How have like-minded shoppers chosen the right health plan or the right care team? Combining consumer feedback with data on a person’s background and behavior can tailor information according to type, making it more meaningful for health decisions. And analyzing that type of comprehensive patient portrait for thousands of customers offers the promise of better population health management.

Changes in reimbursement policies, competition for customers, and the popularity of ratings in this country are prompting the health care industry to ask patients for more than a satisfaction measure. Scores are just a starting point. A valued source of information is something that can accompany a patient throughout the health care journey and prevent unnecessary costs.