Jinnet Briggs Fowles, Ph.D

April 23, 2006

Jinnet Briggs Fowles, Ph.D., is a senior vice president at the Park Nicollet Institute. Fowles' research addresses the use of measurements for quality improvement and public accountability. She specializes in the reliability and validity of differing data sources, including administrative claims data, patient self reports, and ambulatory medical record information. Fowles has served as a measurement consultant for the Institute for Clinical Systems Improvement, the leading quality improvement organization in Minnesota.

After receiving her B.A. in Art History from Wellesley College, Fowles earned her M.S. in Library Science from Simmons College, and her M.S. in Health Services Administration and Ph.D. in Communications Research from Stanford University.

Under the HCFO initiative, Fowles has worked on three projects that examine the use of measurement in the health care market. Most recently, Fowles and principal investigator David Knutson studied the adoption of health-based risk adjustment tools beyond direct health plan payment. Findings from this study indicate that every major national and regional health plan is using health-based risk adjustment for medical and financial applications, with medical management applications most often leading the diffusion. Furthermore, all health benefit and actuarial consulting firms were using health-status based tools for risk assessment and risk adjustment to support purchaser clients. Knutson and Fowles also found that there is an emerging methodological debate about transparency and standardization.

This research is particularly timely, says Fowles. "Increasingly, the health care delivery system relies on measurement in Disease Management Programs, Pay for Performance Programs, and to meet public reporting requirements. As this happens, issues surrounding the integrity of measurement become more and more critical and risk adjustment is part of the story for what makes measurement valid and reliable."

Knutson and Fowles have also explored the impact of risk adjustment tools on the purchaser-health plan relationship. "The Implementation and Impact of Health Based Risk Adjustment," a HCFO funded study, evaluated the implementation of risk-adjustment mechanisms in the following eight markets: Minneapolis, St. Paul, Sacramento, Seattle, Denver, Portland, Phoenix, and Miami. From surveys and interviews with purchasers, the investigators drew three conclusions. First, purchasers can work effectively with plans, making compromises while keeping their primary policy objectives in sight. Second, plans that have or that anticipate low risk scores will launch resistance campaigns or will drop out of the program. Third, specialty providers cannot survive under capitation without health-based risk adjustment.

An earlier HCFO project, led by Fowles, examined the effects of consumer survey-based report cards on the health care market place. She investigated the impact of a Minnesota-mandated report card initiative that began in 1991 and required all health plans selling policies to state employees to participate in a consumer survey-based report card. Fowles found that the introduction of the report card increased attention given to quality improvement and service initiatives within the health plans. What plans valued most-and reacted to most significantly-was their reputation. Concern about reputation was the largest driver of health plans' response, even when they saw that consumers were not likely to react to the report card information.

For more information of Jinnet Briggs Fowles, Ph.D., and a list of selected publications please see: www.parknicollet.com/Institute